Acute isovolaemic haemodilution in two Jehovah's Witnesses presenting for major intracranial surgery.
The Jehovah's Witnesses (JWS) is a religious sect with strong convictions against acceptance of blood and its products for medical care, including surgery. We present two cases of JWS, aged 24 and 19 years old, who had craniectomy for trauma and craniotomy for tumour excision, respectively. A team approach was employed in the care of both patients. During exhaustive preoperative discussions they re-affirmed their religious convictions but agreed to some modifications. Both patients accepted Acute Isovolaemic Haemodilution (AIH). However one of them insisted on non-discontinuation of the line used in collecting the blood from the vein, as that would constitute blood storage. The preoperative Packed Cell Volume (PCV) was 45% and 41% for the trauma and the tumour patients respectively. Two units of blood (1000 ml) were collected from each patient resulting in post donation PCV of 40% and 33%. The intraoperative blood loss was 300 ml and 2000 ml, respectively, and the units and crystalloid fluids were transfused for replacement. Postoperative PCV were 42% and 25%. The latter improved to 30% over the following two weeks with oral haematinics. The two cases are discussed in the light of the experience gained.
Amanor-Boadu
S D
SD
Department of Anaesthesia, College of Medicine, University College Hospital (UCH), Ibadan, Ibadan, Nigeria.
Malomo
A
A
Komolafe
E O
EO
Adeolu
A A
AA
Abdullahi
A
A
Shokunbi
M T
MT
D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous / Q000379:methods*; D001932:Brain Neoplasms / Q000601:surgery; D003399:Craniotomy / Q000009:adverse effects*; D000077324:Crystalloid Solutions; D004909:Erythrocyte Indices; D005625:Frontal Lobe; D006397:Hematinics / Q000627:therapeutic use; D006400:Hematocrit; D006438:Hemodilution / Q000379:methods* / Q000523:psychology; D006801:Humans; D007552:Isotonic Solutions; D033221:Jehovah's Witnesses / Q000523:psychology; D008297:Male; D009777:Occipital Bone / Q000293:injuries; D010294:Parietal Bone / Q000293:injuries; D010296:Parietal Lobe; D019990:Perioperative Care / Q000379:methods / Q000523:psychology; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011300:Preoperative Care / Q000379:methods / Q000523:psychology; D020204:Skull Fracture, Depressed / Q000601:surgery; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000523:psychology
D000077324:Crystalloid Solutions; D006397:Hematinics; D007552:Isotonic Solutions; D010952:Plasma Substitutes