Refusal Of Blood Products Research Articles

Cardiopulmonary Bypass During Pregnancy: A Case Report

(J. Extra-Corpor. Technol 20(2):67-71, 39 references) Reported cases of the pregnant patient during cardiopulmonary bypass are rare but not unique. This case report of the pregnant patient during cardiopulmonary bypass is unique for two reasons. First, the patient was also a Jehovah’s Witness and refused blood products. Secondly, this case report provides a literature review and specific cardiopulmonary bypass considerations pertinent to the perfusionist. Recent literature reports that heart surgery is relatively safe during pregnancy. It is important to monitor fetal heart rate during the procedure not only to determine fetal distress but also to further knowledge in the area by documenting effects. The perfusion circuit must be prepared for the increased blood volume of the patient and still maintain minimal priming volumes. Uterine blood flow is not autoregulated so it is important to maintain adequate cardiac output or blood flow and perfusion pressure during the operation. A cardiac index of 3 liters per minute per meter squared and mean blood pressure of 60 mmHg during our case gave us no signs of fetal distress. The pregnant patient should be maintained at normothermia and bypass times should be kept to a minimum.

Fluosol-DA as a red-cell substitute in acute anemia.

We assessed the safety and efficacy of Fluosol-DA as a red-cell substitute in acute anemia. Twenty-three surgical patients with blood loss and religious objections to receiving blood transfusions were evaluated. Fifteen moderately anemic patients with a mean hemoglobin level (+/- SE) of 7.2 +/- 0.5 g per deciliter had no evidence of a physiologic need for increased arterial oxygen content and did not receive Fluosol-DA. Eight severely anemic patients with a mean hemoglobin level of 3.0 +/- 0.4 g per deciliter met the criteria of need and received the drug until the physiologic need disappeared or a maximal dose of 40 ml per kilogram of body weight was reached. We observed no adverse reactions to Fluosol-DA. The average peak increment in arterial oxygen content with the drug was only 0.7 +/- 0.1 ml per deciliter. There were no appreciable beneficial effects of Fluosol-DA, perhaps because of the small increase in arterial oxygen content, the brief half-life of the drug (24.3 +/- 4.3 hours), and the limited total dose. Six of the eight patients receiving Fluosol-DA died. One of the survivors received red-cell transfusions against his wishes, under a court order, after his total Fluosol-DA dose. Fourteen of the 15 moderately anemic patients survived. The data in this select group of patients refusing blood products suggest that, after blood loss, Fluosol-DA is unnecessary in moderate anemia and ineffective in severe anemia.

Perfluorocarbon infusion in bleeding patients refusing blood transfusions.

Six severely anemic surgical patients who refused blood products were treated with a perfluorochemical (PFC) emulsion (Fluosol-DA 20%). When these patients received high inspired oxygen concentrations, the emulsion resulted in moderate increases of arterial oxygen content but considerable increases of oxygen consumption, suggesting improved microcirculatory oxygen distribution. The mean +/- SD percentages of consumed oxygen transported by dissolved oxygen in PFC and PFC plus plasma emulsions were 22% +/- 5% and 60% +/- 12%, respectively. Several adverse clinical effects were seen, however, including transient decreases in leukocyte counts, hypotension, and abnormal hepatic and pulmonary function.