Bloodless Surgery in a Jehovah's Witness Patient with a 12.7-kg Uterine Leiomyosarcoma.

Nagarsheth NP, Shander A, Malovany R, Tzeng J, Ibrahim I.
Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Englewood Hospital and Medical Center, Englewood, New Jersey and Mount Sinai School of Medicine, New York, New York.

INTRODUCTION: Bloodless surgery aims to optimize outcomes in patients undergoing surgical procedures who wish to avoid allogeneic transfusion. Using a series of interventions and management strategies related to this goal, patients who were previously considered extremely high risk or inoperable without a blood transfusion can now undergo complex surgical procedures with acceptable outcomes. The techniques of bloodless surgery have been incorporated in order to care for a patient with a large uterine sarcoma with involvement and invasion into adjacent organs.

CASE: A 52-year-old female Jehovah's Witness patient refusing allogeneic blood transfusion presented to the gynecologic oncology division with a 40-cm pelvic mass and anemia. She was enrolled into the bloodless surgery program at the authors' institution and subsequently underwent surgical resection of a 12.7-kg uterine leiomyosarcoma. Although her intraoperative course was significant for severe anemia with a hemoglobin of 2.5 g/dl and her postoperative course required long-term hospitalization, the patient regained full function to her preoperative performance status.

CONCLUSIONS: Bloodless surgery in patients with a potential for large-volume intraoperative blood loss requires a well-organized systematic, multidisciplinary approach to achieve the best possible outcome.

PMID: 17706574 [PubMed - in process]

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Source: Bloodless Surgery in a Jehovah's Witness Patient w...[J Surg Educ. 2007 Jul-Aug] - PubMed Result