Intraoperative cell salvage during radical prostatectomy: a safe technique for Jehovahs witnesses

Abstract

Radical retropubic prostatectomy (RRP) is an operation historically associated with the potential for significant blood loss. Patients who refuse a blood transfusion, such as Jehovah's witnesses, may be only offered radiation therapy as potentially curative treatment for prostate cancer because of the potential for a transfusion. Intraoperative cell salvage (IOCS) is an effective blood management strategy for patients who are not willing to accept predonated autologous or allergenic blood. We present our management for Jehovah's Witness patients with clinically localized prostate cancer, emphasizing our blood management approach. This is the first such report.

Intraoperative cell salvage in radical prostatectomy does not appear to increase long‐term biochemical recurrence, metastases, or mortality

“…Interestingly, these findings may be of use in patients undergoing RP for whom allogeneic RBC transfusion is not an option. In a case series of three Jehovah's Witness patients with prostate cancer, ICS was acceptable to the patients and RP was performed without complications or disease recurrence at early follow‐up (3‐9 months) 23 …”

“…In a case series of three Jehovah's Witness patients with prostate cancer, ICS was acceptable to the patients and RP was performed without complications or disease recurrence at early follow-up (3-9 months). 23 The major limitation of this study is the nonrandomization of patients for no ICS versus ICS utilization during RP. However, the two groups were well matched in terms of baseline demographic and prostate cancer characteristics, and all patients from both periods included in the final analysis had surgery performed by the same urologist.…”

Autotransfusion: Therapeutic Principles, Efficacy and Risks

“…Autotransfusion of washed unradiated shed blood is often employed during cystectomies and prostatectomies (Nieder et al 2004, Davis et al 2003, Ford et al 2007, Gallina et al 2007, Stoffel et al 2005, Waters et al 2004). In these studies, blood was collected from the surgical field subsequent to prostatic manipulation.…”

Right trisectionectomy of the liver for intrahepatic cholangiocarcinoma with bile duct invasion in a Jehovah's Witness

“…We were in complete agreement with the anesthesiology team regarding the minimal surgical blood loss and the minimal fluid intake necessary to maintain a low central venous pressure before and during liver transection. Intraoperatively, blood in direct contact with the circulation was salvaged with a cell saver; however, many oncology surgeons are reluctant to use this blood because of the theoretical risk of tumor dissemination . Before one makes a decision to use this blood or not, it is suggested that one should check the patient's condition and complete blood counts.…”

“…Intraoperatively, blood in direct contact with the circulation was salvaged with a cell saver; however, many oncology surgeons are reluctant to use this blood because of the theoretical risk of tumor dissemination. 19 Before one makes a decision to use this blood or not, it is suggested that one should check the patient's condition and complete blood counts. To perform the best oncological surgery, the strategy needs to be perfect.…”