• Nimesh P Nagarsheth, Aryeh Shander, Robert Malovany, Jausheng Tzeng, and Ibrahim Ibrahim.
• Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Englewood Hospital and Medical Center, Englewood, New Jersey, USA. nimesh.nagarsheth@gmail.com
• J Surg Educ. 2007 Jul 1;64(4):212-9.

IntroductionBloodless 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.CaseA 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.ConclusionsBloodless 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.

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