Thoraco-abdominal aneurysm repair in a Jehovah's Witness: maximising blood conservation.
Thoraco-abdominal aneurysm repair usually necessitates blood or blood product transfusion which is prohibited in Jehovah's Witnesses. We report the blood conservation strategy used during thoraco-abdominal aneurysm repair in a Jehovah's Witness. This included pre-operative recombinant erythropoietin, per-operative acute normovolaemic haemodilution, cell salvage, aprotinin, restricted heparinisation, left atrial-distal bypass and recombinant factor VIIa. Post-operative haemoglobin levels were maintained, but a left haemothorax necessitated re-thoracotomy on post-operative day 4. Following re-thoracotomy, Hb was 12.0 g.dL(-1) and platelet count 49 x 10(9).L(-1). Recombinant erythropoietin was recommenced. At discharge (day 12), Hb was 10.1 g.d(L-1). The patient remains well at one year. A thoroughly, pre-planned multi-disciplinary blood conservation strategy can be used to undertake high-risk procedures.
Rahman
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IA
Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Trust, Birmingham, UK.
Hoth
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Doughty
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Bonser
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RS
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D007611:Aprotinin / Q000008:administration & dosage; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004921:Erythropoietin / Q000008:administration & dosage; D006438:Hemodilution / Q000379:methods*; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D033221:Jehovah's Witnesses; D008297:Male; D011300:Preoperative Care; D014057:Tomography, X-Ray Computed
D000925:Anticoagulants; D004921:Erythropoietin; D006493:Heparin; D007611:Aprotinin