Introduction/Background*Blood transfusions are common in the surgical management of gynaecology oncology patients, up to 93% of patients undergoing pelvic exenteration may require blood products. However, increasingly more patients are cautious in receiving blood products, either for fear of potential risks or for religious believes. It is therefore vital to optimize the management of these patients in order to avoid blood transfusions.
We describe the case of a 58-year old female Jehovah’s witness patient undergoing pelvic exenteration, focusing on the preoperative, intraoperative and postoperative measures that allowed an uncomplicated surgery without blood transfusion.
Methodology In this case, we summarize the management of a 58-year old lady who underwent laparotomy, pelvic exenteration, Bricker colicureterostomy, end colostomy formation for recurrent endometrial carcinoma, despite previous total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by brachytherapy, chemotherapy and external beam radiotherapy for high grade serous carcinoma.
Result(s)*Preoperatively, an advance decision to refuse blood products was discussed, to ascertain all the options that were suitable. Since her preoperative haemoglobin was acceptable (127 g/L), no further intervention was required. Intraoperatively, blood loss was effectively minimised with meticulous haemostasis, intraoperative haemodilution and cell salvage. Despite these interventions, total blood loss was 1030mL and postoperative haemoglobin was 113 g/L. Postoperative measures therefore included intravenous iron infusion, minimisation of phlebotomy and optimisation of cardiopulmonary status. Erythropoietin was also considered, but was not necessary as patient responded to the previous measures well and was successfully discharged after an uncomplicated recovery.
Conclusion*Only a few cases of total pelvic exenteration have been described in the literature for Jehovah’s witness patients. However, our case shows that laparotomy and pelvic exenteration is feasible in patients refusing blood products, if performed under a multidisciplinary team and with careful preoperative, intraoperative and postoperative planning, also in the setting of previous radical hysterectomy and co-adjuvant therapy.
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