Anesthetic management for ascending aorta replacement in a patient who refused autologous transfusion for religious reasons

Abstract

We report on the anesthetic management of a 69-year-old female Jehovah's Witness undergoing cardiopulmonary bypass to replace the ascending aorta; the patient refused transfusion of stored autologous or allogeneic blood products for religious reasons. The strategy involved preoperative hematopoiesis with recombinant human erythropoietin and iron, intraoperative acute normovolemic hemodilution, the use of a cell-saver system, administration of high-dose tranexamic acid, controlled hypotension, avoidance of low body temperature, simplification of the surgery, and lower blood dilution during cardiopulmonary bypass.

Management of Combined Cardiac Surgery Using Cardiopulmonary Bypass With Acute Normovolemic Hemodilution in a Jehovah’s Witness: A Case Report

“…There are a few reports about the efficacy of ANH for JW patients undergoing simple cardiovascular surgery under CPB [ 19 , 20 ]. However, this is the first report on the effectiveness of ANH for JW in combined cardiac surgery under CPB with higher transfusion risk and the first to mention the importance of appropriate volumes for ANH considering hemodilution by CPB.…”

Major thoracic surgery in Jehovah's witness: A multidisciplinary approach case report

“…Facing the refusal of a Jehovah’s Witness to accept a blood transfusion, when absolutely necessary for vital reasons, is probably one of the most frustrating situations in medical wards. There may be a furious temptation to overcome this refusal when the situation becomes critical or irreversible [29] Although they do not reject either organ transplantation or red blood cell-depleted stem cell transplants, it can be questioned as to whether they are likely to accept induced pluripotent stem cells or mesenchymal stem cell-derived red blood cells, currently one of the most promising alternatives [30] . The bloodless medicine was initially developed to provide necessary treatment to patients of this faith, but administering bloodless care to Jehovah’s Witnesses, valuable lessons can be learned about the transfusion avoidance strategies.…”