Debbie;

Doesn't sound good. Is her cirrhosis is presently quiet? Meaning, if her liver enzymes are presently not elevated you can possibly recommend a consideration of Sodium Ferric Gluconate IV in half doses but with extreme caution. If she needs valves done and has active disease she will also need to be considered for Novoseven (no albumin) preapproval on reserve. She might be a candidate for cryo back up but if she refuses albumin she surely will refuse cryo. Sad because you don't have a lot of options here. If she is a valve redo, you have even more problems. Her beginning crit isn't bad but with her liver involvement her risk of coag problems are endless. A big challenge for a CV surgeon. Sorry.