[Extreme intraoperative hemodilution in Jehovahs witness patient submitted total proctocolectomy: case report.]

Homologous blood transfusion risks are well known and some patients may refuse blood transfusions on religious grounds. This report aimed at describing a case of total proctocolectomy in Jehovahs Witness patient with 4 g/dL hemoglobin.

Male patient, 17 years old, with family history of adenomatous polyposis. The disease was manifested at eight years of age, characterized by bleeding. At 13 years of age he was submitted to total colectomy. At 17 years of age he was submitted to total proctocolectomy. Patient was prepared with erythropoietin, folic acid, infusion of iron and vitamin B12. Red blood cell count revealed He = 4,200,000/mm(3), hemoglobin = 10.5 g/dL, hematocrit = 37% platelets = 273,000/mm(3) and normal prothrombin time. Patient was continuously monitored with NIBP, pulse oximetry, capnography and ECG. Anesthesia was induced with propofol, sufentanil, pancuronium and enflurane in closed system. Patient received 7,000 mL lactated Ringers and 150 mL of 20% human albumin. Total diuresis was 2,900 mL. Surgery lasted 10 hours and 30 minutes. Patient was referred to the ICU with 20% hematocrit, 2,300,000/mm(3) red cells, 4,2 g/dL hemoglobin and was maintained with propofol and atracurium. Next day evaluation revealed 18% hematocrit, 2,050,000/mm(3) red cells and 4 g/dL hemoglobin. Patient was extubated 18 hours after surgery and was referred to the ward. Patient started eating four days after surgery and was discharged the 10th postoperative day. Thirty days later patient presented 35% hematocrit, 4,000,000/mm(3) red cells and 9.5 g/dL hemoglobin. Six months later he returned for ileostomy closing. Patient was submitted to 12 surgeries without a single blood transfusion.

A good planning of the whole team (clinician, surgeon, anesthesiologist, intensive care staff) allows us to perform surgical procedures associated to major blood losses without administering blood.