title: Bloodless Orthotopic Heart Transplantation in a Jehovah's Witness.
abstract: We present the case of a 53-year-old female Jehovah's Witness with nonischemic cardiomyopathy who successfully underwent a bloodless heart transplantation using fibrinogen concentrate (RiaSTAP; CSL Behring, King of Prussia, PA) and other blood-conservation methods. With a multidisciplinary team and the use of preoperative erythropoietin-stimulating drugs, normovolemic hemodilution, cell salvage, and pharmacotherapy to prevent and treat coagulopathy, we were able to maintain hemoglobin levels greater than 11 g/dL without the need for blood transfusion. We conclude that orthotopic heart transplants may be performed successfully in select Jehovah's Witness patients using standard and novel blood conservation methods.
authors.affiliation: From the Department of Cardiothoracic Anesthesiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Torijaun
authors.initials: T
authors.lastname: Dallas
authors.forename: Ian
authors.initials: I
authors.lastname: Welsby
authors.forename: Brandi
authors.initials: B
authors.lastname: Bottiger
authors.forename: Carmelo
authors.initials: C
authors.lastname: Milano
authors.forename: Mani
authors.initials: M
authors.lastname: Daneshmand
authors.forename: Nicole
authors.initials: N
authors.lastname: Guinn
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000941:ethics; D057668:Bloodless Medical and Surgical Procedures / Q000379:methods*; D009202:Cardiomyopathies / Q000097:blood / Q000601:surgery; D000068817:Epoetin Alfa / Q000008:administration & dosage; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use; D016027:Heart Transplantation / Q000379:methods*; D006397:Hematinics / Q000008:administration & dosage; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D033221:Jehovah's Witnesses; D008875:Middle Aged; D012068:Religion and Medicine; D016896:Treatment Outcome
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D000068817:Epoetin Alfa; D005340:Fibrinogen