Major thoracic surgery in Jehovah's witness: A multidisciplinary approach case report.
BACKGROUND
A bloodless surgery can be desirable also for non Jehovah's witnesses patients, but requires a team approach from the very first assessment to ensure adequate planning.


METHODS
Our patient, a Jehovah's witnesses, was scheduled for right lower lobectomy due to pulmonary adenocarcinoma. Her firm denies to receive any kind of transfusions, forced clinicians to a bloodless management of the case.


CONCLUSIONS
Before surgery a meticulous coagulopathy research and hemodynamic optimization are useful to prepare patient to operation. During surgery, controlled hypotension can help to obtain effective hemostasis. After surgery, clinicians monitored any possible active bleeding, using continuous noninvasive hemoglobin monitoring, limiting the blood loss due to serial in vitro testing. The optimization of cardiac index and delivery of oxygen were continued to grant a fast recovery.


CONCLUSIONS
Bloodless surgery is likely to gain popularity, and become standard practice for all patients. The need for transfusion should be targeted on individual case, avoiding strictly fixed limit often leading to unnecessary transfusion.
AORN dei Colli, Vincenzo Monaldi Hospital, Via Leonardo Bianchi, 80131 Napoli, Italy. Electronic address: marco-rispoli@hotmail.it.
Marco
M
Rispoli
AORN dei Colli, Vincenzo Monaldi Hospital, Via Leonardo Bianchi, 80131 Napoli, Italy. Electronic address: carlo.bergaminelli@libero.it.
Carlo
C
Bergaminelli
AORN dei Colli, Vincenzo Monaldi Hospital, Via Leonardo Bianchi, 80131 Napoli, Italy. Electronic address: mrnespoli@hotmail.it.
Moana Rossella
MR
Nespoli
AORN dei Colli, Vincenzo Monaldi Hospital, Via Leonardo Bianchi, 80131 Napoli, Italy. Electronic address: maesposito15@gmail.com.
Mariana
M
Esposito
AORN dei Colli, Vincenzo Monaldi Hospital, Via Leonardo Bianchi, 80131 Napoli, Italy. Electronic address: dario.mattiacci@libero.it.
Dario Maria
DM
Mattiacci
AORN dei Colli, Vincenzo Monaldi Hospital, Via Leonardo Bianchi, 80131 Napoli, Italy. Electronic address: corcio.ant@libero.it.
Antonio
A
Corcione
AORN dei Colli, Vincenzo Monaldi Hospital, Via Leonardo Bianchi, 80131 Napoli, Italy. Electronic address: salvatorebuono48@gmail.com.
Salvatore
S
Buono
Bleeding monitoring; Bloodless surgery; Case report; Jehovah's witness surgery; Thoracic surgery