Acute normovolemic hemodilution in a Jehovah's Witness patient: a case report

Patients who are Jehovah's Witnesses refuse blood transfusions and blood products as a matter of faith. For surgical procedures during which substantial blood loss is possible, their refusal presents a challenge. 'Anesthetists must generally respect the requests of adults not to receive blood and thus should have a clear understanding of how they will respond in the event of bleeding. Several blood conservation techniques are available for consideration, including acute normovolemic hemodilution. This technique entails the preoperative phlebotomy of whole blood that contains a high concentration of red blood cells and coagulation Patiefactors, while replacing the lost volume with a crystalloid and/or colloid infusion. The procured whole blood can then be transfused back during or after the procedure as a treatment of hypovolemia. Leaving the procured blood continuously attached to the patient through the collection tubing makes the procedure acceptable to most Jehovah's Witness patients. Current literature is unclear when this technique should be used. In this particular case, acute normovolemic hemodilution contributed to the successful outcome of an anemic Jehovah's Witness who was undergoing major surgery.