Volume 10 Supplement 1
A multistage approach to blood conservation in a Jehovah's Witness patient undergoing redo aortic arch surgery
© Basu et al. 2015
Published: 16 December 2015
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.
To describe a multi-stage approach of patient blood management in a Jehovah's Witness undergoing redo aortic arch surgery.
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.
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.
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.
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.
Meticulous multidisciplinary individualised patient blood management can result in safe and excellent outcome in a Jehovah's Witness patient undergoing major redo aortic surgery.
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.
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.