Bloodless surgery in a pediatric Jehovah's Witness

Pediatric cardiac surgery in Jehovah's Witness patients who refuse the use of blood products remains a challenge because of the extreme hemodilution caused by priming the circuit and subsequent cardiopulmonary bypass. We report our successful strategy for reducing the prime volume for a 2-year-old Jehovah's Witness patient who required open heart surgery. We modified our conventional bypass circuit requirements for this size child by incorporating a lower prime oxygenator and reducing the size of the venous line and circuit, which decreased the circuit prime volume. We managed to reduce our initial sanguineous prime volume from 315 to 210 mL. The prime was further reduced to 160 mL by minimizing circuit length at the field and with venous prime sequestration prebypass. The postbypass hematocrit was 31%. Bloodless pediatric cardiac surgery in Jehovah's Witness patients can be performed safely. Incorporating a lower prime oxygenator into a revised circuit alleviated the need for blood transfusion and allowed us to achieve our calculated flow rate of 2.6 L/min/m2 while maintaining a hematocrit of 31%.