• V Casati, A D'Angelo, L Barbato, D Turolla, F Villa, M A Grasso, A Porta, and F Guerra.
• Division of Cardiovascular Anaesthesia and Intensive Care, Policlinico di Monza, Monza, Italy. valter.casati@policlinicodimonza.it
• Br J Anaesth. 2007 Sep 1;99(3):349-52.

AbstractPrevious studies have demonstrated that preoperative haemoglobin concentration and female gender are related to an increased need for perioperative allogeneic transfusions in cardiac surgery. Hence, urgent cardiac surgery presents a dilemma for female patients who are Jehovah's Witnesses, because of their refusal of allogeneic transfusion. This report describes the management of four high-risk anaemic female patients undergoing urgent complex cardiac surgery. In these Jehovah's Witness patients, strict application of a comprehensive blood-sparing protocol permitted safe avoidance of allogeneic transfusions. The protocol involved intraoperative acute normovolaemic haemodilution, intraoperative administration of tranexamic acid, intra- and postoperative use of a cell-saver system, postoperative administration of erythropoietin, iron and folic acid, and a careful surgical technique to avoid perioperative bleeding.

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