Extreme Plasma Dilution Decreases Heparin and Protamine Cardiopulmonary Bypass Requirements: A Case Report on a Jehovah's Witness Patient.
The primary focus of cardiopulmonary bypass management in Jehovah's Witness patients is the need to conserve blood. A consequence of these strategies inevitably results in hemodilution that is frequently extreme enough to dilute clotting factors and potentially impair coagulation. The purpose of this case report is to demonstrate that a hemodiluted patient requires less heparin to sustain anticoagulation and less protamine to reverse heparin at cardiopulmonary bypass termination. Patient harm may ensue unless the effects of extreme hemodilution are recognized.
From the *Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California; and †Department of Pathology & Human Anatomy, Loma Linda University School of Medicine, Loma Linda, California.
Emilie
E
Chang
Jason W
JW
Gatling
Scott
S
Bode
Paul C
PC
Herrmann
Brian S
BS
Bull
Richard L
RL
Applegate
D000925:Anticoagulants / Q000008:administration & dosage*; D001777:Blood Coagulation / Q000187:drug effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D006438:Hemodilution; D006493:Heparin / Q000008:administration & dosage*; D006494:Heparin Antagonists / Q000008:administration & dosage*; D006801:Humans; D033221:Jehovah's Witnesses; D019106:Postoperative Hemorrhage / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D011479:Protamines / Q000008:administration & dosage*; D012068:Religion and Medicine; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016312:Treatment Refusal
D000925:Anticoagulants; D006494:Heparin Antagonists; D011479:Protamines; D006493:Heparin