Acute isovolaemic haemodilution in two Jehovah's Witnesses presenting for major intracranial surgery

Abstract

The Jehovah's Witnesses (JWS) is a religious sect with strong convictions against acceptance of blood and its products for medical care, including surgery. We present two cases of JWS, aged 24 and 19 years old, who had craniectomy for trauma and craniotomy for tumour excision, respectively. A team approach was employed in the care of both patients. During exhaustive preoperative discussions they re-affirmed their religious convictions but agreed to some modifications. Both patients accepted Acute Isovolaemic Haemodilution (AIH). However, one of them insisted on non-discontinuation of the line used in collecting the blood from the vein, as that would constitute blood storage. The preoperative Packed Cell Volume (PCV) was 45% and 41% for the trauma and the tumour patients respectively. Two units of blood (1000ml) were collected from each patient resulting in post donation PCV of 40 % and 33%. The intraoperative blood loss was 300ml and 2000ml, respectively, and the units and crystalloid fluids were transfused for replacement. Post-operative PCV were 42% and 25%. The latter improved to 30% over the following two weeks with oral hematinic. The two cases are discussed in the light of the experience gained.