Pancreaticoduodenectomy without homologous blood transfusion in an anemic Jehovah's Witness
U. Atabek, R. K. Spence, M. Pello, J. Alexander and R. Camishion
Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Camden.
Whipple pancreaticoduodenectomy is an accepted procedure for management of
periampullary and pancreatic carcinomas and has modern mortality rates of
less than 10%. The procedure is associated with significant operative blood
loss. Therefore, blood transfusion is an important supportive measure. We
report the case of a bleeding ampullary carcinoma in a Jehovah's Witness
who refused transfusion of all homologous blood products. Despite a
preoperative hemoglobin level of 51 g/L, curative pancreaticoduodenectomy
was successfully performed. The success of the procedure can be primarily
attributed to careful surgical technique, intraoperative autotransfusion,
avoidance of postoperative complications, minimization of perioperative
phlebotomies, use of human recombinant erythropoietin, and, possibly, the
use of the perfluorocarbon emulsion Fluosol DA-20%. The case illustrates
several important principles for the surgical treatment of patients with
severe anemia who refuse transfusion of homologous blood products.
