Use of desmopressin and erythropoietin in an anaemic Jehovah’s Witness patient with severely impaired coagulation capacity undergoing stentless aortic valve replacement

Abstract

Cardiac surgery in Jehovah's Witness patients remains a challenge in the presence of concomitant congenital or acquired coagulation disorders and anaemia. We report a case of a 66-year-old female Jehovah's Witness suffering from severe calcified aortic valve stenosis requiring aortic valve replacement. The anaemic patient suffered from concomitant platelet dysfunction and deficiency of factors V and VII due to gammopathy of immunoglobulin G. The patient was preoperatively treated with recombinant erythropoietin in combination with folic acid and iron, which resulted in an increase of the haematocrit from 0.335 to 0.416 after 22 days of treatment. Haemostasis was improved by high dose aprotinin and additional desmopressin, which could be demonstrated to be effective by a preoperative test. The patients intra- and postoperative course was uneventful, her total chest tube loss was 130 ml, and she was able to be discharged without the need of any blood transfusions. The beneficial properties of erythropoietin and desmopressin in Jehovah's Witness patients are discussed.

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“…Jehovah's Witnesses refuse transfusions on the basis of religious convictions, but are known to survive trauma and surgery with remarkably low hemoglobin levels. In many cases, these patients do so with the pharmacological support of erythropoietic agents [49-51]. In a case study involving 48 Jehovah's Witness patients, rHuEPO was successfully used to avoid transfusions completely during and after elective coronary and heart valve surgery [52].…”

Perioperative Jehovah's Witnesses: a review

“…[112][113][114] Some papers suggest a preoperative test dose of 0.3 µg kg −1 as an infusion over 30-45 min to ascertain patient response. 115 While several papers have suggested a beneficial effect in Jehovah's Witness patients, a 2004 Cochrane review states that while desmopressin limits perioperative blood loss, the extent is not clinically important and only supports use in patients with inherited bleeding disorders. 116 Specific clotting factors can be replaced individually.…”

Priming Reduced Extracorporeal Circulation Setup (PRECiSe) with the DeltaStream Diagonal Pump

“…Although numerous technical modifications have been made during the past five decades, there are still negative effects in ECC leading to a “systemic inflammatory response” (5) with an impact on different organ systems. The additional transfusion of blood products is a frequent problem in cardiac surgery especially with regard to patients refusing any transfusions of blood or blood products and components (6).…”