Volume 10 Supplement 1

Proceedings of the WSCTS 25th Anniversary Congress

Open Access

A multistage approach to blood conservation in a Jehovah's Witness patient undergoing redo aortic arch surgery

  • Rahul Basu1,
  • Surendra Naik1,
  • Mohammad Shafaat1 and
  • John Lu1
Journal of Cardiothoracic Surgery201510(Suppl 1):A99

https://doi.org/10.1186/1749-8090-10-S1-A99

Published: 16 December 2015

Background/Introduction

49 year old woman with Marfan's syndrome previously treated with aortic root replacement and resuspension of aortic valve for type A dissection. Now presented with progressive dilating 6.3 cm arch aneurysm requiring redo surgery.

Aims/Objectives

To describe a multi-stage approach of patient blood management in a Jehovah's Witness undergoing redo aortic arch surgery.

Method

Preoperative phase

Baseline ferritin, transferrin, B12, folate and TFT levels.

Intravenous iron 1000 mg as single dose 3-5 weeks before planned surgery.

Epoetin alfa (600 units per kg) at weekly intervals starting 3 weeks before surgery and the 4th dose given day before surgery.

Hb improved from 119 to 152g/l.

Perioperative phase

Predonation of 2 units blood at induction.

Usage of aprotinin.

Near normothermic CPB at 30°C.

Usage of Hemosep® device to recover blood spilled during surgery. This preserved platelets, white and red cells for subsequent transfusion.

Postoperative phase

Hb 103g/l immediately post-op but fell to 64g/l over 24h. Therefore ventilated electively for 2 days giving IV iron and erthropoietin at day 1 and 4 to enhance erythropoiesis.

Patient extubated when Hb 79 g/l.

Results

Patient had no re-exploration for bleeding or tamponade. She had a period of CVVH for renal failure and IV antibiotic for chest infection.

She was transferred to the ward on day 9 and discharged home on day 13. Subsequent follow up at week 1 and 6 post discharge showed the patient doing well.

Discussion/Conclusion

Meticulous multidisciplinary individualised patient blood management can result in safe and excellent outcome in a Jehovah's Witness patient undergoing major redo aortic surgery.

Consent

Written informed consent was obtained from the patient for publication of this abstract and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

Authors’ Affiliations

(1)
Trent Cardiac Centre, City campus, Nottingham University Hospitals NHS Trust

Copyright

© Basu et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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