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BJA Advance Access originally published online on June 27, 2007
British Journal of Anaesthesia 2007 99(3):349-352; doi:10.1093/bja/aem170
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Perioperative management of four anaemic female Jehovah’s Witnesses undergoing urgent complex cardiac surgery

V. Casati1,*, A. D'Angelo4, L. Barbato2, D. Turolla2, F. Villa2, M. A. Grasso1, A. Porta3 and F. Guerra2

1 Division of Cardiovascular Anaesthesia and Intensive Care
2 Division of Cardiovascular Surgery
3 Division of Medicine, Policlinico di Monza, Monza, Italy
4 Coagulation Service and Thrombosis Research Unit, Scientific Institute H.S. Raffaele, Milan, Italy

* Corresponding author: Division of Cardiovascular Anaesthesia and Intensive Care Policlinico di Monza via Amati 111, Monza 20052, Italy. E-mail: valter.casati{at}policlinicodimonza.it

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.

Keywords: blood, haemodilution; blood, salvage; complications, Jehovah’s Witness; surgery, cardiovascular; tranexamic acid


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