Thoraco-abdominal aneurysm repair in a Jehovah's Witness: maximising blood conservation

Perfusion
I A RahmanR S Bonser

Abstract

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.

References

May 1, 1991·The Annals of Thoracic Surgery·V A Gaudiani, H D Mason
May 1, 1993·The Annals of Thoracic Surgery·S WestabyC Grebenik

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Citations

Feb 23, 2012·Interactive Cardiovascular and Thoracic Surgery·Miralem PasicRoland Hetzer
Mar 30, 2011·Journal of Cardiac Surgery·Lester GarciaTomas A Salerno
Apr 8, 2015·Journal of Cardiothoracic and Vascular Anesthesia·David W YaffeeEugene A Grossi

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