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Case Reports
. 2014 Jun;46(2):173-6.

Bloodless pediatric cardiopulmonary bypass for a 3.2-kg patient whose parents are of Jehovah's Witness faith

Todd M Ratliff, Ashley B Hodge, Thomas J Preston, Mark Galantowicz, Aymen Naguib, Daniel Gomez
Case Reports

Bloodless pediatric cardiopulmonary bypass for a 3.2-kg patient whose parents are of Jehovah's Witness faith

Todd M Ratliff et al. J Extra Corpor Technol. 2014 Jun.

Abstract

Patients and parents of Jehovah's Witness (JW) faith present multiple challenges to a medical team, especially in the neonatal and pediatric population. The medical team must balance honoring the parents' request of not receiving blood products and fulfilling our commitment as advocates for the child's wellbeing. A multidisciplinary approach to cardiac surgery must be embraced for bloodless cardiopulmonary bypass (CPB) to be successful. At our institution, we have developed strategies and techniques for blood conservation that are used preoperatively, intraoperatively, and postoperatively for every CPB case with the goal of a bloodless procedure. These protocols include: preoperative erythropoietin, preoperative iron administration, selection of a CPB circuit specific to the patient's height and weight, acute normovolemic hemodilution, retrograde autologous prime and venous autologous prime, tranexamic acid administration, zero-balance ultrafiltration, flushing of the pump suckers post-CPB, modified ultrafiltration, and cell salvage. We present an 8-day-old, 3.2-kg patient of JW faith with aortic valve stenosis and regurgitation and a patent foramen ovale who underwent a bloodless left ventricle-to-aorta tunnel repair and aortic valve repair on CPB.

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Conflict of interest statement

The senior author has stated that the authors have reported no material, financial, or other relationship with any healthcare-related business or other entity whose products or services are discussed in this paper.

Figures

Figure 1.
Figure 1.
ANH autotransfusion set up for Jehovah’s Witness patients.
Figure 2.
Figure 2.
Cerebral saturations, hematocrit, and venous saturations throughout the case.
See this image and copyright information in PMC

References

    1. Redlin M, Huebler M, Boettcher W, Kukucka M, Schoenfeld H, Hetzer R, Habazettl H.. Minimizing intraoperative hemodilution by use of a very low priming volume cardiopulmonary bypass in neonates with transposition of the great arteries. J Thorac Cardiovasc Surg. 2011;142:875–881. - PubMed
    1. Olshove VF, Preston T, Gomez D, Phillips A, Galantowicz M.. Perfusion techniques toward bloodless pediatric open heart surgery. J Extra Corpor Technol. 2010;42:122–127. - PMC - PubMed
    1. Halpern NA, Alicea M, Seabrook B, Spungen AM, McElhinney AJ, Greenstein RJ.. Cell saver autologous transfusion: Metabolic consequences of washing blood with normal saline. J Trauma. 1996;41:407–415. - PubMed
    1. Winch P, Naguib A, Bradshaw J, Galantowicz M, Tobias J.. Decreasing the need for transfusion: Infant cardiac surgery using hemodilution and recombinant factor VIIa. Pediatr Cardiol. 2013;34:119–124. - PubMed
    1. Ridley DT.. Jehovah’s Witnesses’ refusal of blood: Obedience to scripture and religious conscience. J Med Ethics. 1999;25:469–472. - PMC - PubMed

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