Blood transfusion-free complex cardiac re-operation in a Jehovah's Witness child by use of a minimized cardiopulmonary bypass circuit and various blood conservation techniques: A case report

Lee, Jong Hyun

Case Report

Cardiothoracic and Vascular Anesthesia

Anesthesia and Pain Medicine 2011;6(2):150-153.
Published online April 30, 2011.

Blood transfusion-free complex cardiac re-operation in a Jehovah's Witness child by use of a minimized cardiopulmonary bypass circuit and various blood conservation techniques: A case report

Jong Hyun Lee

Department of Anesthesiology and Pain Medicine, Sejong General Hospital, Bucheon, Korea. jonghyeonlee@gmail.com

Abstract

Cardiac surgery involving cardiopulmonary bypass (CPB) in patients who are Jehovah's Witnesses, particularly in young children, presents a challenge to the surgical team. In open heart surgery of neonates and small children, the CPB circuit surface and priming volume are relatively large in relation to patient size and blood volume. Therefore, the use of allogeneic blood is inevitable to maintain the optimal hematocrit level during bypass. Strategies to avoid the use of homologous blood products during cardiac surgery must incorporate miniaturization of the CPB circuit as well as other bypass techniques in order to avoid problems like excessive hemodilution. We report a successful surgical correction in a 15.1kg male child who underwent re-operative surgery of a complex congenital heart disease. Our strategies included pre-operative administration of erythropoietin and iron to increase red blood cell mass, cell salvage modified ultrafiltration and vacuum-assisted venous drainage to minimize circuit size and prime volume.

Key Words: Blood transfusion, Cardiac surgery, Cardiopulmonary-bypass, Jehovah's Witness, Pediatric