Bloodless Surgery in a Jehovah’s Witness Patient with a 12.7-kg Uterine Leiomyosarcoma

Nagarsheth, Nimesh P.; Shander, Aryeh; Malovany, Robert; Tzeng, Jausheng; Ibrahim, Ibrahim

doi:10.1016/j.jsurg.2007.03.008

« Previous Next »Journal of Surgical Education
Volume 64, Issue 4 , Pages 212-219, July 2007

Bloodless Surgery in a Jehovah’s Witness Patient with a 12.7-kg Uterine Leiomyosarcoma

Nimesh P. Nagarsheth, MD
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Englewood Hospital and Medical Center, Englewood, New Jersey and Mount Sinai School of Medicine, New York, New York
- Correspondence: Inquiries to Nimesh P. Nagarsheth, MD, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Medical Center, 1176 Fifth Avenue, Box 1173, New York, NY 10029-6574; fax (212) 987-6386
Aryeh Shander, MD
- Department of Anesthesia, Englewood Hospital and Medical Center, Englewood, New Jersey and Mount Sinai School of Medicine, New York, New York
Robert Malovany, MD
- Division of Pulmonary, Department of Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey and Mount Sinai School of Medicine, New York, New York
Jausheng Tzeng, MD
- Department of Pathology, Englewood Hospital and Medical Center, Englewood, New Jersey and Mount Sinai School of Medicine, New York, New York
Ibrahim Ibrahim, MD
- Department of Surgery, Englewood Hospital and Medical Center, Englewood, New Jersey and Mount Sinai School of Medicine, New York, New York

Introduction

Bloodless 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.

Case

A 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.

Conclusions

Bloodless 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

Key Words: uterine leiomyosarcoma, Jehovah’s Witness, anemia, bloodless surgery

Competency: Patient Care, Medical Knowledge, Systems Based Practice