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  • Title: Perioperative management of four anaemic female Jehovah's Witnesses undergoing urgent complex cardiac surgery.
    Author: Casati V, D'Angelo A, Barbato L, Turolla D, Villa F, Grasso MA, Porta A, Guerra F.
    Journal: Br J Anaesth; 2007 Sep; 99(3):349-52. PubMed ID: 17596592.
    Abstract:
    Previous studies have demonstrated that preoperative haemoglobin concentration and female gender are related to an increased need for perioperative allogeneic transfusions in cardiac surgery. Hence, urgent cardiac surgery presents a dilemma for female patients who are Jehovah's Witnesses, because of their refusal of allogeneic transfusion. This report describes the management of four high-risk anaemic female patients undergoing urgent complex cardiac surgery. In these Jehovah's Witness patients, strict application of a comprehensive blood-sparing protocol permitted safe avoidance of allogeneic transfusions. The protocol involved intraoperative acute normovolaemic haemodilution, intraoperative administration of tranexamic acid, intra- and postoperative use of a cell-saver system, postoperative administration of erythropoietin, iron and folic acid, and a careful surgical technique to avoid perioperative bleeding.
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