Major surgery in an osteosarcoma patient refusing blood transfusion: case report

Area of Science:

• Orthopedic Oncology
• Transfusion-Free Medicine

Background:

• Osteosarcoma management often involves blood transfusions due to chemotherapy and surgical demands.
• Jehovah's Witnesses decline blood transfusions, posing challenges in complex oncological cases.

Observation:

• A 16-year-old Jehovah's Witness diagnosed with proximal tibial osteosarcoma.
• The patient required neoadjuvant chemotherapy and extensive surgery (proximal tibia resection with endoprosthesis replacement).

Findings:

• Successful treatment was achieved without allogeneic blood transfusion.
• A multimodal approach including haematinics, granulocyte colony-stimulating factor, recombinant erythropoietin, and intraoperative normovolaemic haemodilution was employed.

Implications:

• Demonstrates the feasibility of managing high-risk osteosarcoma in patients refusing blood transfusions.
• Highlights the critical role of open communication and tailored therapeutic alternatives in respecting patient autonomy and beliefs.