Bloodless Management of Severe Obstetric Hemorrhage With Very Severe Anemia: A Case Report

Abstract

This case report describes bloodless management of a 32-year-old Jehovah’s Witness who had severe obstetric hemorrhage at 23 weeks of gestation, spontaneously delivering twin fetuses. After resuscitation with crystalloids and colloids, the patient was still bleeding and hemoglobin fell to 3.3 g/dL. She had emergency hysterectomy. On postoperative day 1, her hemoglobin was 1.3 g/dL and Glasgow Coma Scale 6 of 15. Electrolyte derangement and fluid overload were detected and treated promptly. She regained consciousness and received intravenous iron and erythropoietin. She recovered fully without complications and without blood transfusion. Hemoglobin at discharge (postoperative day 18) was 6.9 and 12.5 g/dL 4 months later.

A Global Definition of Patient Blood Management

“…62,63 BMS programs provided the proof of concept that effective strategies can be used to reduce the dependency on allogeneic blood, even in acute severely anemic patients and in high blood loss procedures. [64][65][66][67][68] However, there was resistance to the term "bloodless medicine and surgery" and the more generic term "blood conservation" became popular to communicate broader application. 10 Under the blood conservation concept, a patient's own blood is considered a highly valuable and limited resource that must be "conserved and managed appropriately."…”

“…62,63 BMS programs provided the proof of concept that effective strategies can be used to reduce the dependency on allogeneic blood, even in acute severely anemic patients and in high blood loss procedures. 64–68…”