title: Bloodless surgery in a Jehovah's Witness patient with a 12.7-kg uterine leiomyosarcoma.
abstract: BACKGROUND
  Bloodless surgery aims to optimize outcomes in patients undergoing surgical procedures who wish to avoid allogeneic transfusion. Using a series of interventions and management strategies related to this goal, patients who were previously considered extremely high risk or inoperable without a blood transfusion can now undergo complex surgical procedures with acceptable outcomes. The techniques of bloodless surgery have been incorporated in order to care for a patient with a large uterine sarcoma with involvement and invasion into adjacent organs.
  
  
  METHODS
  A 52-year-old female Jehovah's Witness patient refusing allogeneic blood transfusion presented to the gynecologic oncology division with a 40-cm pelvic mass and anemia. She was enrolled into the bloodless surgery program at the authors' institution and subsequently underwent surgical resection of a 12.7-kg uterine leiomyosarcoma. Although her intraoperative course was significant for severe anemia with a hemoglobin of 2.5 g/dl and her postoperative course required long-term hospitalization, the patient regained full function to her preoperative performance status.
  
  
  CONCLUSIONS
  Bloodless surgery in patients with a potential for large-volume intraoperative blood loss requires a well-organized systematic, multidisciplinary approach to achieve the best possible outcome.
authors: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Englewood Hospital and Medical Center, Englewood, New Jersey, USA. nimesh.nagarsheth@gmail.com
authors: Nimesh P
authors: NP
authors: Nagarsheth
authors: Aryeh
authors: A
authors: Shander
authors: Robert
authors: R
authors: Malovany
authors: Jausheng
authors: J
authors: Tzeng
authors: Ibrahim
authors: I
authors: Ibrahim
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D033221:Jehovah's Witnesses; D007890:Leiomyosarcoma / Q000601:surgery*; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D014594:Uterine Neoplasms / Q000601:surgery*