Using acute hypervolaemic haemodilution as blood conservation technique in a Jehovah’s witness patient undergoing an emergency transphenoidal surgery: a Sabah experience

2021 ◽  
Vol 14 (3) ◽  
pp. e241916
Author(s):  
Tat Boon Yeap ◽  
Ming Kai Teah ◽  
Sofan Zenian
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Pituitary Apoplexy ◽  
Anaesthetic Techniques ◽  
Blood Conservation ◽  
Receive Blood Transfusion ◽  
Endoscopic Transsphenoidal Surgery ◽  
Medical Practitioners ◽  
Witness Patient ◽  
Huge Challenge

Jehovah’s Witnesses (JW) is a branch of Christianity which was founded in 1872. However, their beliefs differ from other Christians in many ways. Majority of JW believe that it is against the teaching of God should they receive blood transfusion, while minority think receiving own blood or others is acceptable. These vast beliefs should always be respected by all medical practitioners to avoid medicolegal implications. The differing beliefs about blood transfusion is certainly a huge challenge to the surgeons and anesthesiologists, especially dealing with major surgeries. Thus, effective surgical and anaesthetic techniques are focused to minimise blood loss to avoid unnecessary blood transfusion. We report a JW patient who successfully underwent an emergency endoscopic transsphenoidal surgery secondary to pituitary apoplexy; highlighting our intraoperative acute hypervolaemic haemodilution technique to reduce blood loss.

Anaemia and Skin Pigmentation after Excessive Cupping Therapy by An Unqualified Therapist in Korea: A Case Report

2012 ◽  
Vol 30 (3) ◽  
pp. 227-228 ◽  
Author(s):  
Kun Hyung Kim ◽  
Tae-Hun Kim ◽  
Min Hwangbo ◽  
Gi Young Yang
Keyword(s):  
Case Report ◽  
Iron Deficiency ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Health Professionals ◽  
Skin Pigmentation ◽  
Cupping Therapy ◽  
Deficiency Anemia ◽  
Receive Blood Transfusion ◽  
Subjective Discomfort

A case is reported of skin pigmentation and associated anemia resulting from persistently repeated cupping therapies performed by an unqualified practitioner in South Korea. Almost 30 sessions of excessive cupping therapies with blood loss over two months yielded little benefit but led the patient to admit a hospital and receive blood transfusion for acquired iron deficiency anemia. Skin pigmentation on the cupping-attached region remained without any subjective discomfort. We suggest the importance of qualified health professionals when receiving cupping treatments.

scholarly journals Impact of multidisciplinary engagement in a quality improvement blood conservation protocol for craniosynostosis

2020 ◽  
Vol 26 (4) ◽  
pp. 406-414
Author(s):  
David E. Kurlander ◽  
Mona Ascha ◽  
Danielle C. Marshall ◽  
Derek Wang ◽  
Mustafa S. Ascha ◽  
...  
Keyword(s):  
Critical Care ◽  
Quality Improvement ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Statistical Significance ◽  
Transfusion Rate ◽  
Transfusion Medicine ◽  
Blood Conservation ◽  
Estimated Blood Loss ◽  
The Impact

OBJECTIVEPatients undergoing open cranial vault remodeling for craniosynostosis frequently experience substantial blood loss requiring blood transfusion. Multiple reports in the literature have evaluated the impact of individual blood conservation techniques on blood transfusion rates during craniosynostosis surgery. The authors engaged a multidisciplinary team and assessed the impact of input from multiple stakeholders on the evolution of a comprehensive quality improvement protocol aimed at reducing or eliminating blood transfusion in patients undergoing open surgery for craniosynostosis.METHODSOver a 4-year period from 2012 to 2016, 39 nonsyndromic patients were operated on by a single craniofacial plastic surgeon. Initially, no clear blood conservation protocol existed, and specific interventions were individually driven. In 2014, a new pediatric neurosurgeon joined the craniofacial team, and additional stakeholders in anesthesiology, transfusion medicine, critical care, and hematology were brought together to evaluate opportunities for developing a comprehensive blood conservation protocol. The initial version of the protocol involved the standardized administration of intraoperative aminocaproic acid (ACA) and the use of a cell saver. In the second version of the protocol, the team implemented the preoperative use of erythropoietin (EPO). In addition, intraoperative and postoperative resuscitation and transfusion guidelines were more clearly defined. The primary outcomes of estimated blood loss (EBL), transfusion rate, and intraoperative transfusion volume were analyzed. The secondary impact of multidisciplinary stakeholder input was inferred by trends in the data obtained with the implementation of the partial and full protocols.RESULTSImplementing the full quality improvement protocol resulted in a 66% transfusion-free rate at the time of discharge compared to 0% without any conservation protocol and 27% with the intermediate protocol. The administration of EPO significantly increased starting hemoglobin/hematocrit (11.1 g/dl/31.8% to 14.7 g/dl/45.6%, p < 0.05). The group of patients receiving ACA had lower intraoperative EBL than those not receiving ACA, and trends in the final-protocol cohort, which had received both preoperative EPO and intraoperative ACA, demonstrated decreasing transfusion volumes, though the decrease did not reach statistical significance.CONCLUSIONSPatients undergoing open calvarial vault remodeling procedures benefit from the input of a multidisciplinary stakeholder group in blood conservation protocols. Further research into comprehensive protocols for blood conservation may benefit from input from the full surgical team (plastic surgery, neurosurgery, anesthesiology) as well as additional pediatric subspecialty stakeholders including transfusion medicine, critical care, and hematology.

scholarly journals Safe and effective performance of pediatric spinal deformity surgery in patients unwilling to accept blood transfusion: a clinical study and review of literature

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alexander Mihas ◽  
Subaraman Ramchandran ◽  
Sebastian Rivera ◽  
Ali Mansour ◽  
Jahangir Asghar ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Spinal Deformity ◽  
Intraoperative Complications ◽  
Spine Deformity ◽  
Blood Conservation ◽  
Level Of Evidence ◽  
Estimated Blood Loss ◽  
Spinal Deformity Surgery

Abstract Background Pediatric deformity surgery traditionally involves major blood loss. Patients refusing blood transfusion add extra clinical and medicolegal challenges; specifically the Jehovah’s witnesses population. The objective of this study is to review the safety and effectiveness of blood conservation techniques in patients undergoing pediatric spine deformity surgery who refuse blood transfusion. Methods After obtaining institutional review board approval, we retrospectively reviewed 20 consecutive patients who underwent spinal deformity surgery and refused blood transfusion at a single institution between 2014 and 2018. We collected pertinent preoperative, intraoperative and most recent clinical and radiological data with latest follow-up (minimum two-year follow-up). Results Twenty patients (13 females) with a mean age of 14.1 years were identified. The type of scoliotic deformities were adolescent idiopathic (14), juvenile idiopathic (1), neuromuscular (3) and congenital (2). The major coronal Cobb angle was corrected from 55.4° to 11.2° (80% correction, p <  0.001) at the latest follow-up. A mean of 11.4 levels were fused and 5.6 levels of Pontes osteotomies were performed. One patient underwent L1 hemivertebra resection and three patients had fusion to pelvis. Estimated blood loss, percent estimated blood volume loss, and cell saver returned averaged 307.9 mL, 8.5%, and 80 mL, respectively. Average operative time was 214 min. The average drop in hemoglobin after surgery was 2.9 g/dL. The length of hospital stay averaged 5.1 days. There were no intraoperative complications. Three postoperative complications were identified, none related to their refusal of transfusion. One patient had in-hospital respiratory complication, one patient developed a late infection, and one patient developed asymptomatic radiographic distal junctional kyphosis. Conclusions Blood conservation techniques allow for safe and effective spine deformity surgery in pediatric patients refusing blood transfusion without major anesthetic or medical complications, when performed by an experienced multidisciplinary team. Level of evidence Level IV.

scholarly journals Blood Conservation Strategies in Total Hip and Knee Arthroplasty

2015 ◽  
Vol 4 (4) ◽  
pp. 39-45 ◽  
Author(s):  
David Liu ◽  
Michael Dan ◽  
Natalie Adivi
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Conservation Strategies ◽  
Patient Specific ◽  
Allogenic Blood Transfusion ◽  
Transfusion Rate ◽  
Blood Conservation ◽  
Total Hip ◽  
Hip And Knee Arthroplasty

Peri-operative blood management is one of a number of components important for successful patient care in total joint arthroplasty and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risks of blood transfusion whilst at the same time maximizing haemaglobin in the post-operative period, thereby leading to a positive effect on early and long term outcomes and costs. An individualized strategy based on patient specific risk factors, anticipated blood loss and co-morbidities is useful in achieving this aim. Multiple blood conservation strategies are available in the pre-operative, intra-operative and post-operative periods and can be utilised either individually or in combination. Recent literature has highlighted the importance of identifying and correcting pre-operative anaemia, salvaging peri-operative red cells and the use of tranexamic acid in reducing blood loss. Given total hip and knee arthroplasty is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal. 

scholarly journals Safe and Effective Performance of Pediatric Spinal Deformity Surgery in Patients Unwilling to Accept Blood Transfusion: A Clinical Study and Review of Literature

2020 ◽  
Author(s):  
Alexander Mihas ◽  
Ramchandran Subaraman ◽  
Sebastian Rivera ◽  
Ali Mansour ◽  
Jahangir Asghar ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Spinal Deformity ◽  
Intraoperative Complications ◽  
Spine Deformity ◽  
Blood Conservation ◽  
Level Of Evidence ◽  
Estimated Blood Loss ◽  
Spinal Deformity Surgery

Abstract Background: Pediatric deformity surgery traditionally involves major blood loss. Patients refusing blood transfusion add extra clinical and medicolegal challenges; specifically the Jehovah’s witnesses population. The objective of this study is to review the safety and effectiveness of blood conservation techniques in patients undergoing pediatric spine deformity surgery who refuse blood transfusion Methods: After obtaining institutional review board approval, we retrospectively reviewed 20 consecutive patients who underwent spinal deformity surgery and refused blood transfusion at a single institution between 2014 and 2018.We collected pertinent preoperative, intraoperative and most recent clinical and radiological data with latest follow-up (minimum two-year follow-up).Results: Twenty patients (13 females) with a mean age of 14.1 years were identified. The type of scoliotic deformities were adolescent idiopathic (15), neuromuscular (3) and congenital (2). The major coronal Cobb angle was corrected from 55.40 to 11.20 (80% correction, p< 0.001) at the latest follow-up. A mean of 11.4 levels were fused, 5.6 levels of Pontes osteotomies and 2.8 levels of thoracoplasty performed. 1 patient underwent L1 VCR and 3 patients had fusion to pelvis. Estimated blood loss and cell saver returned an average of 307.9 ml and 80ml, respectively. Operative times average at 214 min. The average drop in hemoglobin after surgery was 2.1mg/dl. The length of hospital stay averaged 5.1 days. There were no intraoperative complications. Three postoperative compilations were identified, none related to their refusal of transfusion. One patient had in-hospital respiratory complication, one patient developed a late infection, and one patient developed asymptomatic radiographic distal junctional kyphosis.Conclusions: Blood conservation techniques allow safe and effective spine deformity surgery in pediatric patients refusing blood transfusion without major anesthetic or medical complications.Level of Evidence: Level IV.

scholarly journals Blood Conservation in Scoliosis Surgery

2017 ◽  
Vol 51 (2) ◽  
pp. 68-73
Author(s):  
Rajat Verma
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Deformity Correction ◽  
Allogeneic Blood Transfusion ◽  
Allogeneic Blood ◽  
Scoliosis Surgery ◽  
Corrective Surgery ◽  
Blood Conservation ◽  
Allogeneic Transfusion ◽  
Correction Surgery

ABSTRACT Spinal deformity correction surgery can result in significant blood loss. Historically, large volumes of allogeneic blood transfusion were used in these patients. There is now an increasing awareness of the need to reduce allogeneic transfusion as there are reported adverse effects. Reducing blood loss during scoliosis surgery is a multipronged approach. This study reviews current strategies to reduce requirements for allogeneic blood transfusion for scoliosis corrective surgery. How to cite this article Verma R. Blood Conservation in Scoliosis Surgery. J Postgrad Med Edu Res 2017;51(2):68-73.

scholarly journals Intraoperative cell salvage use reduces the rate of perioperative allogenic blood transfusion in patients undergoing periacetabular osteotomy

2019 ◽  
Vol 6 (3) ◽  
pp. 277-283 ◽  
Author(s):  
Michael van der Merwe ◽  
Nicholas J Lightfoot ◽  
Jacob T Munro ◽  
Matthew J Boyle
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Periacetabular Osteotomy ◽  
Allogenic Blood Transfusion ◽  
Transfusion Rate ◽  
Cell Salvage ◽  
Blood Conservation ◽  
Allogenic Blood ◽  
Significant Difference ◽  
Clinical Records

Abstract Blood loss during periacetabular osteotomy (PAO) is variable, with losses ranging from 100 to 3900 ml in published series. Perioperative allogenic blood transfusion is frequently utilized although is associated with significant risk of morbidity. Cell salvage (CS) is a common blood conservation tool; however, evidence supporting its use with PAO is lacking. Our aim was to assess whether CS affects perioperative allogenic blood transfusion rate in patients undergoing PAO. The clinical records of 58 consecutive PAOs in 54 patients (median age 24.7 years, interquartile range 17.8–29.4 years) performed by a single surgeon between 1 January 2016 and 30 April 2018 were reviewed. Autologous blood pre-donation and surgical drains were not used. Due to variable technician availability, CS was intermittently used during the study period. PAOs were allocated into a CS group or no cell salvage group (NCS group), according to whether an intraoperative CS system was used. There was no significant difference in patient age, gender, body mass index, dysplasia severity, regional anesthetic technique, tranexamic acid administration, surgical duration or estimated blood loss (all P > 0.05) between the two groups. The CS group had a lower preoperative hemoglobin compared to the NCS group (median, 13.4 g/dl versus 14.4 g/dl, P = 0.006). The incidence of allogenic blood transfusion was significantly lower in the CS group compared to the NCS group (2.5% versus 33.3% patients transfused, P = 0.003). Multivariate modeling showed CS use to be protective against allogenic blood transfusion (P = 0.003), with an associated 80-fold reduction in the odds of transfusion (odds ratio, 0.01; 95th% CI, 0–0.57). To our knowledge, this is the first study to assess the effect of CS use on allogenic transfusion rate in patients undergoing PAO. Our results demonstrate CS to be a mandatory component of blood conservation for all patients undergoing PAO.

scholarly journals Severe intraoperative bleeding predicts the risk of perioperative blood transfusion after robot-assisted radical prostatectomy

2021 ◽  
Author(s):  
Antonio Benito Porcaro ◽  
Riccardo Rizzetto ◽  
Nelia Amigoni ◽  
Alessandro Tafuri ◽  
Aliasger Shakir ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Univariate Analysis ◽  
Operating Time ◽  
Primary Treatment ◽  
Intraoperative Blood Loss ◽  
Robot Assisted ◽  
Intraoperative Bleeding ◽  
Perioperative Blood Transfusion

AbstractTo evaluate potential factors associated with the risk of perioperative blood transfusion (PBT) with implications on length of hospital stay (LOHS) and major post-operative complications in patients who underwent robot-assisted radical prostatectomy (RARP) as a primary treatment for prostate cancer (PCa). In a period ranging from January 2013 to August 2019, 980 consecutive patients who underwent RARP were retrospectively evaluated. Clinical factors such as intraoperative blood loss were evaluated. The association of factors with the risk of PBT was investigated by statistical methods. Overall, PBT was necessary in 39 patients (4%) in whom four were intraoperatively. Positive surgical margins, operating time and intraoperative blood loss were associated with perioperative blood transfusion on univariate analysis. On multivariate analysis, the risk of PBT was predicted by intraoperative blood loss (odds ratio, OR 1.002; 95% CI 1.001–1.002; p < 0.0001), which was associated with prolonged operating time and elevated body mass index (BMI). PBT was associated with delayed LOHS and Clavien–Dindo complications > 2. In patients undergoing RARP as a primary treatment for PCa, the risk of PBT represented a rare event that was predicted by severe intraoperative bleeding, which was associated with increased BMI as well as with prolonged operating time. In patients who received a PBT, prolonged LOHS as well as an elevated risk of major Clavien–Dindo complications were seen.

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