Blood management in Jehovah's Witness patients.




   Preoperative:

  • Anemia: consider iron, folate, erythropoietin;
  • Anticoagulation: Early withdrawal of antiplatelet agents and warfarin. Switch to unfractionated heparin if necessary;



  Anesthesia:

  • Acute normovolemic hemodilution (ANH) : involves a controlled removal of whole blood ( 10-15 ml/kg) immediately prior to the operation. The patient's intravascular volume is maintained with solutions that contain non-red cells. The operative procedure is conducted with a normal blood volume, but with a reduced red cell mass. At the conclusion of the operation, the stored autologous blood is restored to the patient. If operative blood loss is not excessive, the replacement of autologous blood may provide an acceptable red cell mass; 
  • Pharmacologic: consider antifibrinolytic;

 Blood Salvage: 
  • Discuss with the patient;

Surgical: 
  • Meticulous attention to hemostasis;

Postoperative:
  • Bleeding: early re-exploration;
  • Severe anemia increase risk of multi-organ failure and infection;
  • Renal failure: consider peritoneal dialysis.

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