title: [Severity of anemia and operative morbidity and mortality. Report on 3 clinical cases in Jehovah's Witnesses and review of the literature].
abstract: It has been reported that patients who refuse blood transfusions, such as Jehovah's witnesses, can undergo major surgery. In a review of the literature, however, we critically examined the severity of anaemia in relation to operative mortality and morbidity rates. We report three cases of Jehovah's witnesses who underwent major surgery and presented complication during the postoperative period. Case 1: a 50-year-old man with oesophageal achalasia who underwent Heller's myotomy and Nissen's fundoplication. The postoperative period was complicated by massive haemorrhage and the patient was reoperated on postoperative day 1. After four years, he underwent total oesophagectomy because of severe chronic oesophagitis. On postoperative day 13 the patient suffered anteroseptal myocardial ischaemia, which was treated with medical therapy. Case 2: a 40-year-old man, admitted for ulcerative rectocolitis, who underwent total colectomy. On postoperative day 1 he presented massive haemorrhage and shock. He was reoperated and the postoperative period was complicated by myocardial ischaemia, renal failure and an enterocutaneous fistula. Case 3: a 65-year-old woman with ulcerative rectocolitis who underwent total colectomy and a temporary ileostomy. She suffered venous thrombosis of the lower limbs and pulmonary oedema. The patient died 14 months after surgery as a result of massive haemolysis by cryoagglutinins and cardiac arrest.
authors.affiliation: Divisione di Chirurgia Generale A, Dipartimento di Chirurgia Generale, Specialità Chirurgiche e Trapianti d'Organo Paride Stefanini.
authors.forename: Delia
authors.initials: D
authors.lastname: Proposito
authors.forename: Roberto
authors.initials: R
authors.lastname: Gramolini
authors.forename: Valerio
authors.initials: V
authors.lastname: Corazza
authors.forename: Barbara
authors.initials: B
authors.lastname: Mancini
authors.forename: Stefano
authors.initials: S
authors.lastname: Gallina
authors.forename: Leonardo
authors.initials: L
authors.lastname: Montemurro
authors.forename: Salvatore
authors.initials: S
authors.lastname: Veltri
authors.forename: Manlio
authors.initials: M
authors.lastname: Carboni
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000150:complications* / Q000628:therapy; D001803:Blood Transfusion; D002835:Christianity; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000601:surgery; D004931:Esophageal Achalasia / Q000601:surgery; D016629:Esophagectomy; D004941:Esophagitis / Q000601:surgery; D005260:Female; D018662:Fundoplication; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012068:Religion and Medicine; D012086:Reoperation; D012771:Shock, Hemorrhagic / Q000209:etiology; D013514:Surgical Procedures, Operative / Q000401:mortality
vernacular_title: Morbi-mortalità operatoria relativa alla severità dell'anemia acuta. Presentazione di 3 casi clinici complicati in pazienti Testimoni di Geova e revisione della letteratura.