Multidisciplinary management of a Jehovah’s Witness patient for the removal of a renal cell carcinoma extending into the right atrium

Abstract

P Pu ur rp po os se e: : To highlight the management of a Jehovah's witness surgical patient presenting for cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest. C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 47-yr-old male, Jehovah's Witness, with renal cell carcinoma was admitted for left radical nephrectomy and excision of tumour thrombus extending into the junction of the inferior vena cava (IVC) and right atrium (RA). The preoperative goals were to maximize red blood cell mass, delineate the extent of tumour extension and develop a surgical plan incorporating blood conservation strategies to minimize blood loss. A midline abdominal incision was made to optimize removal of the non-caval portion of the tumour from the intra-abdominal region. CPB and deep hypothermic circulatory arrest were instituted to aid in removing the tumour from the IVC and RA. Intraoperative blood conservation strategies included the use of acute normovolemic hemodilution, antifibrinolytics, cell salvage, point-of-care monitoring of heparin and protamine blood concentrations, leukocyte-depleting filter, and meticulous surgical techniques. The patient was successfully weaned from CPB and was transported to the cardiothoracic intensive care unit without complication. The patient was discharged home one week after the operation with a hemoglobin of 10.2 g·dL -1 and a hematocrit of 31.2%.

Cerebral oximetry monitoring during aortic arch aneurysm replacement surgery in Jehovah's Witness patient -A case report-

“…To prevent this, we administered transxanemic acid [12] and a urinary trypsin inhibitor. Although the recombinant activated Facto VIIa [13] is useful for successfully managing anesthesia in JW patients, we did not use it in the present case.…”

Microvascular free‐tissue transfer for head and neck reconstruction in Jehovah's Witness patients

“…To reduce intraoperative bleeding, the antifibrinolytic, tranexamic acid, and the protease inhibitor, aprotinin, have been described. 8,12 As a bovine protein, however, aprotinin may not be acceptable to all Jehovah's Witness patients and must be utilized only after informed consent.…”

Echocardiography images of inferior vena cava tumour thrombus in patient with renal cell carcinoma

“…Clinical reports have highlighted the role of the TEE in patients undergoing renal cell carcinoma excision utilizing cardiopulmonary bypass. 1,2 In this case, TEE imaging provided real-time guidance to surgical excision of a large renal cell carcinoma.…”