title: Spine tumor resection among patients who refuse blood product transfusion: a retrospective case series.
abstract: OBJECTIVE
  To describe the perioperative blood conservation strategies and postoperative outcomes in patients who undergo complex spinal surgery for tumor resection and who also refuse blood product transfusion.
  
  
  METHODS
  A retrospective case series.
  
  
  METHODS
  A single-center, tertiary care and academic teaching hospital in Canada.
  
  
  METHODS
  All adult patients undergoing elective major spine tumor resection and refusing blood product transfusion who were referred to our institutional Blood Utilization Program between June 1, 2004, and May 9, 2014.
  
  
  METHODS
  Data on the use of iron, erythropoietin, preoperative autologous blood donation, acute normovolemic hemodilution, antifibrinolytic therapy, cell salvage, intraoperative hypotension, and active warming techniques were collected. Data on perioperative hemoglobin nadir, adverse outcomes, and hospital length of stay were also collected.
  
  
  RESULTS
  Four patients who refused blood transfusion (self-identified as Jehovah's Witnesses) underwent non-emergent complex spine surgery for recurrent chondrosarcoma, meningioma, metastatic adenocarcinoma, and metastatic malignant melanoma. All patients received 1 or more perioperative blood conservation strategy including preoperative iron and/or erythropoietin, intraoperative antifibrinolytic therapy, and cell salvage. No patients experienced severe perioperative anemia (average hemoglobin nadir, 124 g/L) or anemia-related postoperative complications.
  
  
  CONCLUSIONS
  Patients who decline blood product transfusion can successfully undergo major spine tumor resection. Careful patient selection and timely referral for perioperative optimization such that the risk of severe anemia is minimized are important for success.
authors.affiliation: Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: Sandy.Kisilevsky@vch.ca.
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Kisilevsky
authors.affiliation: Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: liamstobart@gmail.com.
authors.forename: Liam
authors.initials: L
authors.lastname: Stobart
authors.affiliation: Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: kristine.roland@vch.ca.
authors.forename: Kristine
authors.initials: K
authors.lastname: Roland
authors.affiliation: Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: alana.flexman@vch.ca.
authors.forename: Alana M
authors.initials: AM
authors.lastname: Flexman
mesh_terms: D000328:Adult; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001804:Blood Transfusion, Autologous / Q000379:methods; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006438:Hemodilution / Q000379:methods; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007501:Iron / Q000627:therapeutic use; D033221:Jehovah's Witnesses; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000601:surgery*
chemical_list: D000933:Antifibrinolytic Agents; D004921:Erythropoietin; D007501:Iron
keywords: Blood conservation; Jehovah's witness; Outcomes; Spine surgery; Tumor