title: Perioperative management of four anaemic female Jehovah's Witnesses undergoing urgent complex cardiac surgery.
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.
authors.affiliation: Division of Cardiovascular Anaesthesia and Intensive Care, Policlinico di Monza, Monza, Italy. valter.casati@policlinicodimonza.it
authors.forename: V
authors.initials: V
authors.lastname: Casati
authors.forename: A
authors.initials: A
authors.lastname: D'Angelo
authors.forename: L
authors.initials: L
authors.lastname: Barbato
authors.forename: D
authors.initials: D
authors.lastname: Turolla
authors.forename: F
authors.initials: F
authors.lastname: Villa
authors.forename: M A
authors.initials: MA
authors.lastname: Grasso
authors.forename: A
authors.initials: A
authors.lastname: Porta
authors.forename: F
authors.initials: F
authors.lastname: Guerra
mesh_terms: D000368:Aged; D000740:Anemia / Q000150:complications*; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures; D000075202:Contraindications; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D033221:Jehovah's Witnesses; D019990:Perioperative Care / Q000379:methods