Korean J Anesthesiol.  2007 May;52(5):530-536. 10.4097/kjae.2007.52.5.530.

Cardiac Surgeries without Transfusion

Affiliations
  • 1Departments of Anesthesiology and Pain Medicine, Sejong General Hospital, Bucheon, Korea. leee3874@hanmail.net
  • 2Departments of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea.

Abstract

BACKGROUND: Jehovah's Witnesses are well known for their refusal of blood transfusions which, challenges the safety of performing cardiac surgeries. Their stand regarding blood transfusions has garnered criticism from some medical and legal sources, but has also added incentive for the development of many bloodless surgery techniques. To assess the impact on the continuing progress of blood saving protocols and increasing operative risk; herein our results in this specific population are reported.
METHODS
The medical records of Jehovah's Witnesses, who underwent cardiac surgeries without blood transfusions, between Feb 1996 and Sep 2005, were retrospectively reviewed.
RESULTS
103 surgical procedures were performed on 102 patients. The age of patients varied from 2 months to 78 years, with a sex ratio of 60:42 (Male:Female). Cardiopulmonary bypass (CPB) was used in 81 cases. The mean hemoglobin (Hb) and hematocrit (Hct) levels were 13.2 g/dl (8.1-17.3), and 39.2% (24.3-52.5) before surgery, and 11.8 g/dl (8.0-16.5), and 35.3% (24-49) after surgery, respectively. Recombinant human erythropoietin (rHuEPO) and iron were used in 95 and 69 cases before and after surgery, respectively. High dose aprotinin (2 million KIU IV loading dose, 2 million KIU into the pump prime volume and 500,000 KIU per hour of surgery as a continuous intravenous infusion) was used in 67 cases. Acute normovolemic hemodilutions were performed in 7 cases. Cell saver was used in all procedures. Re-operations were needed in two cases due to wound infections and one patient died-of arrhythmias on the 2nd post-operative day.
CONCLUSIONS
Bloodless cardiac surgery can be performed on Jehovah's Witnesses, but effective care of such patients requires close collaborative team efforts and advance planning to ensure favorable outcomes. At our hospital, preoperative iron and rHuEPO, as well as high dose aprotinin and cell saver are routinely used where indicated.

Keyword

bloodless; cardiac surgery; erythropoietin; Jehovah's Witnesses

MeSH Terms

Aprotinin
Arrhythmias, Cardiac
Blood Transfusion
Bloodless Medical and Surgical Procedures
Cardiopulmonary Bypass
Disulfiram
Erythropoietin
Hematocrit
Hemodilution
Humans
Iron
Jehovah's Witnesses
Medical Records
Motivation
Retrospective Studies
Sex Ratio
Thoracic Surgery
Wound Infection
Aprotinin
Disulfiram
Erythropoietin
Iron
Full Text Links
  • KJAE
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr