Accept Blood Transfusion Research Articles

Evaluation Effectiveness of Pre-Treatment Combined with Ultrasound-Guided Suction Curettage in Cesarean Scar Pregnancy: A Retrospective Cohort Study

Background: The objective of this study is to assess the effectiveness of ultrasound-guided suction curettage (UGSC) in conjunction with or without high-intensity focused ultrasound (HIFU) or uterine artery embolization (UAE) for the treatment of three distinct types of cesarean scar pregnancy (CSP). Methods: This was a retrospective study that included subjects diagnosed with CSP in a single tertiary referral centre from January 2015 to December 2020. UGSC associated with/without pretreatment was offered to CSP patients according to the location of pregnancy sac, the depth of implantation and the surrounding blood flowing. The data about baseline characteristics and outcome parameters were analyzed across the three groups. Results: The present study included 434 patients diagnosed with CSP. The majority were cured without severe complication except one case accepted blood transfusion. The baseline data from the three groups did not differ statistically. The UGSC group had the same successful rate of treating type I CSP with a shorter hospital stay (χ2 = 51.771, p = 0.000) compared to the HIFU or UAE groups. Type II CSP presented marked less blood loss (Z = –2.464, p = 0.014) and higher decline ration of beta-human chorionic gonadotropin (β-HCG) (Z = –4.728, p = 0.000) in HIFU group. Treatment success was high in patients with type III CSP in both the HIFU and UAE groups, but the rate of β-HCG decline was higher in the HIFU group (Z = –2.255, p = 0.024). Conclusions: This study suggests that UGSC is an effective and safe option for patients with low-risk CSP. HIFU or UAE combined with UGSC has higher efficacy in high-risk CSP. And HIFU may be superior in reducing bleeding and increasing the rate of β-HCG decline.

Bloodless Total Hip Arthroplasty in Jehovah’s Witness Patients: Contemporary Strategies and Outcomes

BackgroundReported blood transfusion rates in total hip arthroplasty (THA) range between 3 and 22%. Jehovah’s Witnesses (JW) do not accept blood transfusions and make conscience decisions to accept blood derivatives. This study reports on strategies and outcomes for bloodless THA. MethodsAll JW patients undergoing primary THA at our institution between 2011 and 2022 were included in this study (94 of 110 THA). The indications for THA were osteoarthritis (92%), femoral neck fracture (6%), rheumatoid arthritis (1%), and failed open reduction and internal fixation (1%). Strategies used to optimize outcomes included erythropoietin, tranexamic acid, cell savers, intrailiac artery tourniquets, and minimizing phlebotomy. ResultsThe mean estimated blood loss was 201.2 ± 122.2 mL. Preoperative hemoglobin (Hgb) levels were 13.4 ± 1.4 g/dL, which decreased to 11.0 ± 1.3 g/dL on postoperative day 1 (POD1, P < 0.001), 10.3 ± 1.5 g/dL on POD2 (P = 0.001), and 9.8 ± 1.1 g/dL on POD3 (P = 0.171). The use of tranexamic acid significantly decreased Hgb drop on POD1 (P = 0.04). Subgroup analysis showed that preoperatively anemic patients (closed circuit, Hgb < 12 g/dL) had significantly less Hgb drop postoperatively (P = 0.003). No patients met the recommended transfusion threshold (Hgb < 7 g/dL). There were two 90-day readmissions due to falls. There was zero 90-day mortality. ConclusionsA THA can be safely performed on JW patients. Preoperatively anemic patients had a decreased Hgb drop postoperatively. JW patients make a conscious decision to accept blood derivatives, which may be present in medications including erythropoietin. We recommend maintaining an Hgb above 11 g/dL prior to surgery, as a Hgb drop of 3.1 g/dL can be expected. These findings highlight the efficacy of a multimodal approach to optimizing bloodless primary THAs.

The impact of a bloodless medicine program on pancreatic resections: A single-institution experience incorporating patients with borderline-resectable and locally advanced pancreatic cancer

BackgroundPatients undergoing pancreatic resection who decline blood transfusion represent a clinical challenge. While bloodless medicine programs are valuable, their impact remains unclear, especially for those with borderline-resectable and locally advanced pancreatic ductal adenocarcinoma (PDAC). MethodsRetrospective review of institutional databases identified patients who did not accept blood transfusion and underwent pancreatic resection from 2013–2022. We collated hemoglobin values, interventions to minimize symptomatic anemia, and patient outcomes. ResultsThirteen patients were identified. Median age was 63 years (range: 52–75 years) and eight (61.5 %) were female. All procedures were performed electively for invasive malignancy with PDAC as the most common diagnosis (11/13; 84.6 %) and pancreaticoduodenectomy as the most common procedure (11/13; 84.6 %). Vascular involvement was common in the 11 patients with PDAC (borderline-resectable: 7/11; 63.6 % and locally advanced: 3/11; 27.3 %), as was the use of multi-agent chemotherapy (n = 10) and preoperative radiotherapy (n = 8) prior to surgery. Median blood loss was 400 mL (range: 100–2200 mL). Intraoperative measures included acute normovolemic hemodilution in one patient and red blood cell salvage in three patients. Median preoperative hemoglobin was 12.3 g/dL (range: 10.3–14.2 g/dL) and median nadir hemoglobin was 9.2 g/dL (range: 5.2–11.8 g/dL). Median hospital stay was 10 days (range: 6–42 days). Thirty-day mortality was 0 % and one-year overall survival was 69.2 % with median follow-up of 26.4 months. ConclusionPancreatic resections can be performed safely in patients who decline blood transfusion, even with borderline-resectable and locally advanced PDAC. Avoiding transfusions and employing blood-conservation techniques does not appear to detrimentally impact survival.

Provision of Timely Alternative Multidisciplinary Protocols for Patients Refusing Blood or Blood Products

Blood components and products are life-saving therapeutics but with inherent, life-threatening risks. There are patients who do not accept blood products for different reasons, including fear of blood borne viruses, transfusion reactions and religious beliefs. It is important to determine the standard of care and outcomes for such patients, within any clinical setting. The aim of this audit was to evaluate adherence to the agreed standard of care for patients who do not accept blood transfusion. Methods All patients who refused transfusions between 2019 and 2021 were included. Scanned forms and Electronic Patient Records were used to gather data. Expected care standards were: (1) a multidisciplinary team (MDM) led alternative care plan, agreed at least 3 weeks prior to the intervention/ procedure, to prepare for blood loss, and (2) that the MDM should involve: either a surgeon or physician, anaesthetist (if the treatment is surgical or antenatal), haematologist or transfusion practitioner and the patient. Results There were 195 patients referred to MDMs, of which 105 were surgical (54%), 52 were interventional (27%) and 38 were antenatal (19%). Of these, 188 (96%) were sent before a procedure (or birth) with the remaining 7 (4%) referred for ongoing treatment of medical patients, i.e. with severe anaemia. In 72 patients (38%) the MDM did take place ≥3 weeks before the procedure (similar to the results from the first cycle of the audit, in 2017-18 = 40%). Almost 85% (165) of MDM included all relevant stakeholders. Discussion The delay in timely referral for MDM led alternative care plan was likely due to a lack of awareness of transfusion policies, and potentially could lead to cancellation of the procedure or unavailability of alternative protocols in an emergent scenario during surgery or intervention. Conclusion Improvement was required for safer procedures and outcomes, by investment in training, regular refreshers/ updates for staff and electronic protocols/ prompts.

A Novel Technique for Autograft Preparation Using Patient-Specific Instrumentation (PSI) Assistance in Total Hip Arthroplasty in Developmental Dysplasia of Hip (DDH).

Due to the change in the structure of the proximal femur and acetabulum in patients with developmental dysplasia of the hip, total hip arthroplasty (THA) was difficult to perform for surgeons. To elevate the acetabular coverage rate, we developed a technique in the use of a patient-specific instrumentation (PSI) graft in patients with developmental dysplasia of hip (DDH) undergoing surgery. This study aims to evaluate the peri-operative outcomes of THA with PSI graft in patients with DDH. This study recruited 6 patients suffering from Crowe I DDH with secondary Grade IV osteoarthritis. All the patients underwent THA with PSI graft performed by a well-experienced surgeon. Perioperative outcomes included surgical procedures, blood loss during operation, the volume of blood transfusion, length of hospitalization, complications, and the mean difference in hemoglobin levels before and after surgery. All the outcomes analyzed were assessed by mean and standard deviation. The average duration of the surgical procedure was found to be 221.17 min, with an SD of 19.65 min. The mean blood loss during the operation was 733.33 mL, with an SD of 355.90 mL. The mean length of hospital stay was calculated to be 6 days, with an SD of 0.89 days. Furthermore, the mean difference between the pre- and postoperative hemoglobin levels was 2.15, with an SD of 0.99. A total of three patients received 2 units of leukocyte-poor red blood cells (LPR) as an accepted blood transfusion. There were no reported complications observed during the admission and one month after the operation. This study reported the peri-operative outcomes in the patients with DDH who underwent THA with PSI graft. We found that THA with PSI graft would provide a safe procedure without significant complications. We assumed that the PSI graft in THA may increase the coverage rate of the acetabulum, which may increase the graft union rates. Further cohort studies and randomized controlled trials were needed to confirm our findings.

TOTAL HIP ARTHROPLASTY IN A JEHOVAH'S WITNESS, WITHOUT BLOOD TRANSFUSION, AFTER ACETABULAR FRACTURE: CLINICAL REPORT AND LITERATURE REVIEW

Patients who are Jehovah's witnesses do not accept blood transfusions. Thus, total hip arthroplasty can be challenging in this group of patients due to the potential for blood loss. Multiple strategies have been developed in order to prevent blood loss.A 76-year-old female, Jehovah's witness medicated with a platelet antiaggregant, presented to the emergency department after a fall from standing height. Clinically, she had pain mobilizing the right lower limb and radiological examination revealed an acetabular fracture with femoral head protrusion and ipsilateral isquiopubic fracture. Skeletal traction was applied to the femur during three weeks and no weight bearing was maintained during the following weeks. Posteriorly, there was an evolution to hip osteoarthritis with necrosis of the femoral head.The patient was submitted to surgery six months after the initial trauma, for a total hip arthroplasty. The surgery was performed with hypotensive anaesthesia, careful surgical technique and meticulous haemostasis and there was no need for blood transfusion. Posteriorly, there was a positive clinical evolution with progressive improvement on function and deambulation.Total hip arthroplasty may be safely carried out with good clinical outcomes in Jehovah's witnesses, without the need for blood transfusion, if proper perioperative precautions are taken, as has already been shown in previous studies.

MM-531 Case Control Study of Outcomes of Autologous Stem Cell Transplantation in Jehovah's Witness Multiple Myeloma Patients

Jehovah's Witnesses (JW) persons do not accept blood transfusions. Autologous stem cell transplantation (ASCT) after using high-dose chemotherapy is the standard of care in treatment of multiple myeloma (MM). Patients usually require blood transfusions during ASCT. We sought to analyze safety outcomes of single or tandem ASCT in JW MM patients. We performed a case control study at the University of Arkansas for Medical Sciences for JW and non-JW MM patients who underwent single or tandem ASCT from 1990-2021. Matching (1:2) was done based on age, date of MM diagnosis, race/ethnicity, performance status, stage indicated by International Staging System (ISS), and number of ASCT. Wilcoxon Rank-Sum test was used to test continuous variables, while Fisher's exact test was used for categorical variables. A total of 13 JW MM patients received ASCT in the study period (8 single, 5 tandem) compared to 26 non-JW MM patients (16 single, 10 tandem). For JW patients who received single ASCT, median age was 66 (range:65.8-67.5 years), 50% were female, 62.5% were black. Average CD34 stem cells collected/infused were 23/5.8 million cells in JW compared to 30.1/5.1 million cells in non-JW, respectively. For JW patients who received tandem ASCT, median age was 49 (range:46-52 years), 50% were female, 62.5% were black. Average CD34 stem cells collected/infused were 34/10.8 million in JW compared to 21.3/8.8 million in non-JW, respectively. Lowest hemoglobin and platelets level in JW were 6.6 g/dl and 3000 k/uL, respectively. 100-days mortality for all patients was 0%. Multivariable analysis showed no significant difference in 30 days/100 days re-hospitalization, major and/or minor bleeding adverse events, response to treatment (very good partial response or better). Bloodless single/tandem ASCT can be done safely for selected JW MM patients with no significant difference in safety/outcomes.

Transfusion-free Retransplantation for Post-liver Transplantation Hepatic Artery Thrombosis: How Much Augmentation Is Too Much?

Liver transplantation presents unique challenges in patients who do not accept blood transfusions. The difficulty of balancing chemical augmentation and handling the technical difficulty of the surgery make transfusion-free liver transplantation an exception rather than the norm. However, at our center, we have performed 27 successful living donor liver transplants in transfusion-free patients. We describe a case of hepatic artery thrombosis (HAT) after living donor liver transplantation requiring retransplantation. This first report of safe retransplantation without blood products demonstrates that even graft-threatening complications can be safely managed in a transfusion-free setting. However, it remains unclear if the medical augmentation to meet hematologic and coagulation parameters before transfusion-free transplantation may increase the risk of postoperative HAT and other thrombotic complications. Although it is our center’s experience that the thrombosis rate is comparable with the published rate in standard transfusion-eligible living donor liver transplantations and this case demonstrates that HAT can be safely managed in this setting, further study on the risks and benefits of hematopoietic stimulants as pretransplant optimization is warranted.

Vena Cava Tumor Thrombus Associated With Renal Angiomyolipoma in a Jehovah's Witness Patient

We present a case of a young premenopausal female patient who was found to have a left-sided renal mass consistent with angiomyolipoma (AML) with Mayo Level IIIa vena caval tumor thrombus. The patient is of Jehovah's witness faith and would not accept blood transfusion. The following case report discusses workup and treatment for AML with tumor thrombus extension, as well as pre-operative optimization and intra-operative techniques during nephrectomy and thrombectomy to minimize blood loss in a patient unaccepting of blood transfusion.

Use of Hemoglobin Based Oxygen Carrier HBOC-021 (Hemopure) As a Bridge during Emergencies in Patients Unable to Receive Blood Products: Experience at a Tertiary Care Center

IntroductionThere are about 1.1 million Jehovah's witnesses (JW) in the United States who do not accept blood transfusions due to religious beliefs. When these patients present with severe anemia, management is challenging and mortality high. Hemoglobin based Oxygen Carrier HBOC-201 has been available for compassionate use, but its use is limited due to lack of experience. Here we present the experience of a tertiary care center with HBOC-201 to better manage critically ill JW patients with anemia.Case159 y.o. JW female was admitted with diabetic ketoacidosis, right lower extremity gangrene, and sepsis. Labs showed WBC 17.4, Hgb 7.9, and platelets 434. Within hours, the patient went into septic shock requiring vasopressors and mechanical ventilation, AKI requiring dialysis, and transaminitis. Her Hgb dropped to 6.9. She was started on insulin drip and broad-spectrum antibiotics. Her clinical condition improved, vasopressors were discontinued and she was extubated. She subsequently had a below knee amputation. On post-operative day 2, her condition worsened. She developed fevers and vasopressors were restarted. Her Hgb dropped to 5.8. Erythropoietin injections and Iron supplementation were initiated. At this point, the surgical team planned for an above knee amputation for better control of the infection, with a pre-operative goal Hgb of 8. On post-op day 7, the patient's clinical status deteriorated, and she was re-intubated and found to have an embolic stroke. Her Hgb continued to drop to 5.3 and she subsequently received 2 units of HBOC in preparation for urgent surgical intervention for infection control. Her Hgb improved to 6.5 following administration of 2 units of HBOC. Despite the improvement in Hgb, she acutely worsened with increased vasopressor and ventilation requirement, severe acidosis, methemoglobinemia, elevated troponin (0.5), and hypoglycemia. On the next day, she went into cardiac arrest and died.Case249 y.o. JW male was admitted with acute pancreatitis. Labs showed WBC 12.9, Hgb 18.6, transaminitis and lipase >600. The patient's clinical status improved with conservative management but on day 3 developed hematemesis with a drop in Hgb to 9.7. He became lethargic and was subsequently intubated. Esophagogastroduodenoscopy (EGD) showed a gastroesophageal junction clot. Gastrointestinal bleeding persisted over the next 3 days with drop in Hgb to 5. EGD showed an ulcer with visible vessel. Apart from proton pump inhibitor drip, he was also started on Erythropoeitin , B12 and Iron Despite these measures, his Hgb continued to drop with a nadir of 3.3 and worsening clinical status requiring multiple vasopressors. On Day 9, HBOC was approved for compassionate use. The patient was infused 4 units of HBOC. Hgb improved to 5.2, and the patient was weaned off vasopressors. A repeat EGD with injection and cauterization of the bleeding vessel were performed. The patient received one unit of HBOC daily to keep Hgb>5 (figure 1) and the gastroduodenal artery was embolized. The patient developed complications from HBOC, including hypernatremia, alkalosis and methemoglobinemia successfully treated with ascorbic acid and methylene blue. Troponin was normal and EKG was normal. Two days later, he developed lactic acidosis, ventilator associated pneumonia, acute respiratory distress syndrome, shock and multiorgan failure and succumbed to his illness. During this time, his Hgb was stable at 6.1 and there was no further bleeding.ConclusionHBOC-021 (Hemopureâ) is a polymerized bovine hemoglobin. It has been used for management of anemia in JW patients under compassionate-use FDA guidelines with varying success. Our experience with HBOC shows that it can be used successfully in emergencies to hemodynamically stabilize patients. Our first patient showed an improvement in Hgb while our second patient attained a stable Hgb and recovered from his hemorrhagic shock. With clinical improvement, he could get an EGD and embolization done which controlled his bleeding. The side effects of HBOC are easily managed with supportive care and methylene blue. We believe that Intensivists and Hematologists should be aggressively involved in JW patients who urgently need but refuse blood transfusion. An institution based protocol should be available to rapidly obtain HBOC. Efforts should be made to minimize blood loss and the use of erythropoiesis stimulating agents should be maximized. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

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

BackgroundPediatric 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.MethodsAfter 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).ResultsTwenty 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.ConclusionsBlood 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 evidenceLevel IV.

The right of Jehovah's witnesses to refuse and to accept blood transfusion

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Artificial Blood: The History and Current Perspectives of Blood Substitutes.

Blood transfusions are one of the most common procedures performed in hospitalized patients. Yet, despite all of the measures taken to ensure the safety of the blood supply, there are known risks associated with transfusions, including infectious and noninfectious complications. Meanwhile, issues with blood product availability, the need for compatibility testing, and the storage and transport requirements of blood products, have presented challenges for the administration of blood transfusions. Additionally, there are individuals who do not accept blood transfusions (e.g., Jehovah’s Witnesses). Therefore, there is a need to develop alternative agents that can reliably and safely replace blood. However, although there have been many attempts to develop blood substitutes over the years, there are currently no such products available that have been approved by the United States Food and Drug Administration (FDA). However, a more-recently developed hemoglobin-based oxygen carrier has shown promise in early clinical trials and has achieved the status of “Orphan Drug” under the FDA.

Major liver surgery in a Jehovah’s Witness patient: challenges for safe surgery

Jehovah’s Witnesses presenting for major surgery run the risk of major bleeding, which is complicated by the refusal to accept blood transfusion. We present a case of a 63-year-old woman, a Jehovah’s Witness, who was diagnosed with hepatocellular carcinoma and advised for curative laparoscopic liver segmentectomy. Due to the risk of significant intraoperative haemorrhage, her perioperative care was coordinated in a multidisciplinary manner. Informed consent requires the physician to advise on the material risks of undertaking major surgery without blood transfusion and the possible alternatives. Conflicting ethical issues of patient autonomy and beneficence related to refusal of blood products also arise. Perioperative strategies to minimise blood loss, maximise haematopoiesis and tolerance of anaemia to facilitate safe surgery in such patients are also presented. Written patient consent obtained.

Medicine, religion and faith: issues in Jehovah’s Witnesses and major surgery

Background: Major surgical treatment in Jehovah’s Witnesses (JW) presents complex ethical and legal issues to the physician. The Jehovah’s Witness is willing to accept all medical treatment except blood transfusion; and so, the physician is often confronted with a difficult task especially in emergency settings and among minors. This paper looks at the ethical and legal aspects of this peculiar religious sect in relation to surgical treatment. It also provides guidelines for contemporary management of JW using transfusion avoidance strategies. Methodology: Medical literature on the subject was reviewed using manual library search, articles in journals and internet search. The search words were: Jehovah’s Witness + blood transfusion +legal and ethical issues. The search was done using Pubmed, Medline, Hinari and Medscape, as search engines. The search covered a period between 1940 and 2013. Results: Jehovah's witnesses do not argue that blood transfusions have not kept alive patients who otherwise might have died, "but to them, such life is vacuous”. Jehovah's Witnesses, therefore, are exercising a fundamental right of any sane adult with capacity to refuse medical treatment. There is, however, no conclusive evidence that Jehovah's Witnesses have a higher mortality rate after traumatic injury or surgery despite their refusal to accept blood transfusion. As a result of these findings, an increasing number of patients are refusing blood transfusion even for non-religious reasons. Transfusion avoidance strategies are, therefore, desirable. These strategies are likely to gain popularity, and become standard practice for all patients. Dearth of legal statutes in our environment is a major limitation. The legal issues sometimes are conflicting in the setting of emergency and minors. Conclusion: Respect for a patient’s wish and autonomy is sacrosanct. Where a sane adult has expressly rejected a particular treatment option, applying the same option in whatever guise is unethical, and legally, damaging. When in doubt, especially in the minors, the doctor should obtain a court order before administering the life-saving treatment. Every hospital must have institutional protocols for managing these patients.

Major pancreatic resection in Jehovah's witness patients: a single institute experience

Background: The patient’s refusal to accept blood transfusions during major abdominal surgery forces the surgeon to face an ethical challenge and raises doubts about the appropriate perioperative management of these patients. The aim of this study is to present our experience and assess the safety of bloodless major pancreatic surgery. Methods: We retrospectively analysed perioperative outcomes of 25 unselected Jehovah's witness who underwent surgery for pancreatic and periampullary tumors between 2010 and 2016. In collaboration of a multidisciplinary team, we treated perioperative anaemia with drugs stimulating erythropoiesis (erythropoietin, iron and folic acid). Results: 18 patients underwent pancreaticoduodenectomy, 3 spleen-preserving left pancreatectomy, 3 distal splenopancreatectomy, 1 total pancreatectomy. Median estimated intraoperative blood loss was 400mL (300 to 700mL). Median preoperative and postoperative day 1 values of Hb was 14g/dL (12 to 16) and 12g/dL (9 to 15), respectively. 10 (40%) patients had Clavien-Dindo < 3 complications: 6 pancreatic fistula (5 grade A and 1 grade B), 3 delayed gastric emptying, 1 abdominal collection, 1 biliary fistula, and 1 pulmonary thromboembolism. Only 1 patient had an abdominal fluid collection that required percutaneous drainage (Clavien-Dindo >3). In hospital mortality was 0%. Median length of stay was 16 days (8 to 30). Conclusion: Multidisciplinary approach and specific perioperative management permit safe pancreatic resections in Jehovah’s Witness patients.

Perioperative management of cataract surgery in patients with severe systemic diseases

Objective To evaluate the efficacy of perioperative management in cataract patients with severe systemic diseases. Methods Data of 55 eyes of 40 cataract patients with severe systemic diseases in Bazhou Area of Xinjiang were collected and retrospectively analyzed. They underwent cataract surgery. The preoperative managements included discontinuing anticoagulant drugs 7 days preoperatively in patients with coronary artery stent implantation and cerebral infarction. If there was no bleeding 3 days postoperatively, the anticoagulant drugs were restarted.No Heparin used during renal dialysis in patients with renal insufficiency from 1 day before surgery to 7 days after surgery. If there was no bleeding 7 days postoperatively, the Heparin dialysis was restarted. Patients with idiopathic thrombocytopenic purpura accepted blood transfusion preoperatively, which made platelets reaching more than 50×109/L. Patients with leukemia in plateau were kept in a stable phase after systemic treatment preoperatively. The surgical options included phacoemulsification in 52 eyes of 38 patients and extracapsular cataract extraction in 3 eyes of 2 patients. Posterior chamber intraocular lens were implanted in capsular bag of all patients.The follow-up time was 2-4 months. Results Three days postoperatively, cornea edema occurred in 6 eyes, anterior chamber exudates in 3 eyes, and temporary elevation of intraocular pressure in 1 eye respectively. One week postoperatively, severe anterior chamber exudates in 2 eyes, viral keratitis in 1 eye. No obvious progression of systemic disease observed during follow-up period. The visual accuity was improved after surgery. Conclusion Systemic diseases are positive controlled, they can undergo cataract surgery successfully and gain better prognosis. Key words: Cataract; Perioperative period; Systemic diseases, severe

Skuteczna chemioterapia indukująco-konsolidująca u 20-letniej chorej na ostrą białaczkę promielocytową niewyrażającej zgody na przetoczenia preparatów krwiopochodnych z powodu przekonań religijnych

This paper describes a case of 20 years old woman with acute promyelocytic leukemia who refused to accept blood transfusion because of religious beliefs. Individualized induction chemotherapy with daunorubicin, cladribine, cytarabine and all-trans retinoic acid was administered and complete remission was achieved. Grade 4 leukopenia, anemia and thrombocytopenia was observed during induction chemotherapy. Then three consecutive consolidation cycles were given without important complications. In control molecular analysis after induction-consolidation therapy there was no PML-RARA fusion gene detected.

Perioperative Intravenous Iron Sucrose and Erythropoitin Therapy for Hysterotomy and Myomectomy in a Jehova Witness

Jehovah rsquo s Witness persons don rsquo t accept blood transfusion due to religious objections Hence alternative should be used to avoid blood transfusion for surgery on them We present a case in which iron sucrose and erythropoietin was successfully used to raise Hb level and blood transfusion could be avoided

Safety and efficacy of partial nephrectomy for solitary kidney tumor

Objective: To explore the safety and clinical efficacy of partial nephrectomy for solitary kidney tumor. Methods: Twenty patients with a functional or anatomic solitary kidney who underwent nephron-sparing surgery for one or more renal masses were retrospectively analyzed. There were 15 male and 5 female patients with mean age of 63 years.Patients were divided into open partial nephrectomy(OPN) group and laparoscopic partial nephrectomy(LPN) group, the two groups were followed up.Demographic and clinical characteristics were analyzed using student t-test for continuous variables, and the χ2 test for categorical variables. Results: There were 21 tumors whose maximum diameter were 1.5 to 6.0 cm, the mean size was (3.7±1.3)cm, mean operative time was (205.3±81.8)minutes, and median estimated blood loss was 385.6 ml.Five cases accepted blood transfusion intro-operation, 1 case appeared leakage of urine post-operation, none had obvious fever.Eighteen cases were clear cell carcinoma, 2 cases were chromophobe renal carcinoma, 1 case was papillary renal cell carcinoma.Seventeen cases were T1aNxM0, 3 cases were T1bNxM0, 1 case was T3NxM0.One case lost to follow up, the others had completed a mean follow-up of 21.5 months (ranging from 1 to 53 months). One case recurred, no one had metastasis, all patients were alive.The hemoglobin ((114.9±19.6)g/L) and estimated glomerular filtration rate(eGFR) ((46.5±18.2) ml/min) of postoperative day were lesser than pre-operation ((130.7±18.8)g/L, (58.0±16.4) ml/min), while the serum creatinine was higher ((123.8±39.8) μmol/L vs.(90.9±33.2) μmol/L). Three months after operation, hemoglobin, serum creatinine and eGFR had no difference with pre-operative.Compared with OPN group, LPN group gain less blood loss (306 ml vs.510 ml)(t=-2.38, P=0.03), had shorter length of stays (15 d vs.21 d)(t=-3.34, P=0.04), had longer time of renal artery clamping (25.8 min vs.16.5 min)(t=2.60, P=0.02). Conclusions: Partial nephrectomy is secure and effective selection for solitary kidney tumor.The LPN has less trauma, gain less blood loss, recover faster and has shorter length of stays than the OPN, which needs shorter ischaemic time.