Non-blood medical care in gynecologic oncology: a review and update of blood conservation management schemes

Simou, Maria; Thomakos, Nikolaos; Zagouri, Flora; Vlysmas, Antonios; Akrivos, Nikolaos; Zacharakis, Dimitrios; Papadimitriou, Christos; Dimopoulos, Meletios Α.; Rodolakis, Alexandros; Antsaklis, Aris

doi:10.1186/1477-7819-9-142

Cited by 5 publications

(6 citation statements)

References 41 publications

(73 reference statements)

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“…This case report demonstrates the effectiveness of alternative interventions in bloodless surgery, showing that radical and extensive gynecological oncology surgeries can be feasible in patients refusing blood transfusions if careful preoperative, intraoperative, and postoperative measures are applied. Surely, increasingly more patients are cautious in receiving blood products, either for fear of potential risks or for religious believes 7 . It is therefore vital to optimize the management of these patients in order to avoid blood transfusions.…”

Section: Discussionmentioning

confidence: 99%

The role of multidisciplinary team and stepwise pelvic devascularization to minimize blood loss during total pelvic exenteration for patients refusing blood transfusion

Le Thanh,

Bell,

Symons

et al. 2023

Clinical Case Reports

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Key Clinical MessageRadical gynecology oncology surgeries are feasible in patients refusing blood transfusion, when performed with careful preoperative (with hemoglobin optimization and patients' counseling), intraoperative (with hemostasis and stepwise devascularization, hemodilution, and autologous cell salvage) and postoperative (considering iron infusion or erythropoietin) planning with a multidisciplinary team involvement.AbstractWe describe the case of a female Jehovah's Witness patient in her 60s undergoing pelvic exenteration, focusing on the preoperative, intraoperative, and postoperative measures that allowed an uncomplicated surgery without blood transfusion. Blood transfusions are common in the surgical management of gynecology oncology patients, up to 93% of patients undergoing pelvic exenteration may require blood products. However, increasingly more patients are cautious in receiving blood products, either for fear of potential risks or for religious believes. It is therefore vital to optimize the management of these patients in order to avoid blood transfusions. In this case, we summarize the management of a lady in her 60s who underwent laparotomy, pelvic exenteration, Bricker colicureterostomy, and end colostomy formation for recurrent endometrial carcinoma, despite previous total abdominal hysterectomy and bilateral salpingo‐oophorectomy followed by brachytherapy, chemotherapy, and external beam radiotherapy for high‐grade serous carcinoma. Preoperatively, an advance decision to refuse blood products was discussed to ascertain all the options that were suitable. As her preoperative hemoglobin was acceptable (127 g/L), no further intervention was required. Intraoperatively, blood loss was effectively minimized with meticulous hemostasis, stepwise pelvic devascularization, intraoperative hemodilution, and cell salvage. Despite these interventions, total blood loss was 1030 mL and postoperative hemoglobin was 113 g/L. Postoperative measures therefore included intravenous iron infusion, minimization of phlebotomy, and optimization of cardiopulmonary status. Erythropoietin was also considered, but was not necessary as patient responded to the previous measures well and was successfully discharged after an uncomplicated recovery. Only few cases of total pelvic exenteration have been described in the literature for Jehovah's Witness patients. However, our case shows that laparotomy and pelvic exenteration is feasible in patients refusing blood products, if performed under a multidisciplinary team and with careful preoperative, intraoperative, and postoperative planning, also in the setting of previous radical hysterectomy and co‐adjuvant therapy.

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Section: Discussionmentioning

confidence: 99%

The role of multidisciplinary team and stepwise pelvic devascularization to minimize blood loss during total pelvic exenteration for patients refusing blood transfusion

Le Thanh,

Bell,

Symons

et al. 2023

Clinical Case Reports

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“…Responsible surgeons always operate on all of their patients according to the same BSS rules. They should not rely on the fact that the concerned patient has "sufficient blood reserves" and that in case of emergencies, the option to perform blood transfusion is always available [11][12][13].In all cases, collaboration between the surgeon and anesthetist is indispensable. The latter must always assess patients' general medical conditions prior to the operation itself.…”

Section: Discussionmentioning

confidence: 99%

Bloodless Surgery at Jehovah ́s Witnesses

Kudela¹,

Pilka²,

Dzvinčuk³

et al. 2020

BJSTR

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The aim of this research is to present our experiences with the surgical treatment of gynecological patients among Jehovah's Witnesses. Moreover, the medical, moral, and ethical problems in this regard have been highlighted.Methods: Between 2007 and 2018,75 Jehovah's Witnesses patients were operated on for various benign and malignant gynecological diseases. All these patients were operated according to the rules of blood-sparing surgery. Results:The operations were assessed according to the diagnosis, mode of surgery, estimated blood loss and the disease outcome. Excessive blood loss did not occur during any of these operations, and the estimated blood loss for the same was 10 to 550 cc.

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“…The contemporary sophisticated surgical and anesthesiological techniques used by a skilled and experienced surgeon guarantee the performance of most routine operations with acceptable risk. There are only a few very complicated and high risk cases where surgery is not justified [3][4][5][6]. and the operation being performed by a skilled surgeon.…”

Section: Discussionmentioning

confidence: 99%

The Gynecological Surgery of Jehovah´s Witnesses

Kudela¹

2015

Gynecol Obstet

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Objective: To present our experience with the surgical treatment of various diseases in patients belonging to the Church of Jehovah´s witnesses. Methods:The study included 34 patients belonging to the Church of Jehovah´s witnesses who rejected blood transfusion. The operations on these patients were performed for malignant and benign disorders that could not be treated by conservative therapeutic procedures. Results:The operation records were evaluated according to a set of criteria including the type of surgical procedure estimated amount of blood loss, postoperative complications and the outcome of surgical treatment. The lest amount blood loss was secured by the robotic surgery. Conclusion:Jehovah´s witnesses represent a risk group of patients because of their refusal of blood transfusion. Indication for the operation and its performance represent serious decision steps that are always associated with a certain degrese of risk. However when the principles of bloodless surgery are followed the therapeutic results are very good and in the properly indicated cases the scope of risk is acceptable.

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Non-blood medical care in gynecologic oncology: a review and update of blood conservation management schemes

Cited by 5 publications

References 41 publications

The role of multidisciplinary team and stepwise pelvic devascularization to minimize blood loss during total pelvic exenteration for patients refusing blood transfusion

The role of multidisciplinary team and stepwise pelvic devascularization to minimize blood loss during total pelvic exenteration for patients refusing blood transfusion

Bloodless Surgery at Jehovah ́s Witnesses

The Gynecological Surgery of Jehovah´s Witnesses

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