Successful Surgical Treatment of a Ruptured Abdominal Aortic Aneurysm Without Homologous Blood Transfusion in a Jehovah's Witness: Report of a Case

Abstract

We report herein the case of a 47-year-old woman of the Jehovah's Witness faith in whom Y-grafting for a ruptured abdominal aortic aneurysm was successfully performed without a homologous blood transfusion. We used a Cell Saver (Haemonetics, Braintree, MA. USA) red cell salvaging device and an aortic occlusion balloon catheter, and performed gentle and minimal dissection during the operation. Postoperatively. the patient was kept heavily sedated and required hypothermic therapy for only 14h. We treated her severe anemia using conventional drugs, including iron and folic acid, and her hemoglobin increased smoothly. Although her hemoglobin level decreased to 2.8g/dl during the operation, her postoperative course was uneventful.

A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination

“…3), 56.1 mmHg in rAAA and 52.4 mmHg other types of patients in established hemorrhagic shock, among the 23 studies [10, 12, 22, 25, 29–31, 34, 36, 40, 41, 44, 45, 47, 48, 52, 55, 58, 59, 62, 66, 71, 97, 104, 105, 111] reporting pre-REBOA and post-REBOA SBP values.…”

“…REBOA balloon occlusion times were adequately reported in 35 studies [10, 12, 23, 25, 26, 29–34, 36, 38–41, 43–45, 47, 48, 55, 58, 62, 66, 68–71, 82, 83, 97, 101, 104, 105]. Occlusion times within the zones of occlusion were described in 15 studies examining Zone I occlusion times, where 196 patients had a median occlusion time of 58.4 min.…”

Extremely severe anaemia in a critically ill patient who declined a blood transfusion

“…Surprisingly, this patient had normal blood lactate levels, despite an extremely low arterial oxygen content of 2·3 mL dL −1 (one tenth of normal levels) upon admission to our hospital. Several successful cases with extremely low Hb levels [nadir Hb <3 g dL −1 (Baker et al, 1998;Namura et al, 2001), nadir <2 g dL −1 (Brimacombe et al, 1991;Schalte et al, 2005)] have been reported. It was shown previously that in patients who declined transfusion with low nadir Hb levels (Hb <8·0 g dL −1 ), the occurrence of patients with nadir Hb levels <2·0 g dL −1 was rare (frequency 0-2·3%) (Carson et al, 2002;Shander et al, 2014).…”

Perioperative use of recombinant activated factor VII in a Jehovah’s Witness patient undergoing sigmoid colectomy

“…Although complex surgery associated with major blood loss has conventionally been contraindicated in Jehovah’s Witness patients, such procedures have been successfully performed when a multidisciplinary approach has been taken to conserve blood. Numerous case reports and articles have described the management of Jehovah’s Witness patients with severe blood loss or undergoing surgical procedures 1–6 . The aims of interventions are to minimize blood loss, maximize blood production, regulate blood volume and maintain normovolemia, increase the oxygen‐carrying capacity of the blood, and decrease the metabolic rate.…”