Thoraco-abdominal aneurysm repair in a Jehovah's Witness: maximising blood conservation.

Thoraco-abdominal aneurysm repair usually necessitates blood or blood product transfusion which is prohibited in Jehovah's Witnesses. We report the blood conservation strategy used during thoraco-abdominal aneurysm repair in a Jehovah's Witness. This included pre-operative recombinant erythropoietin, per-operative acute normovolaemic haemodilution, cell salvage, aprotinin, restricted heparinisation, left atrial-distal bypass and recombinant factor VIIa. Post-operative haemoglobin levels were maintained, but a left haemothorax necessitated re-thoracotomy on post-operative day 4. Following re-thoracotomy, Hb was 12.0 g.dL(-1) and platelet count 49 x 10(9).L(-1). Recombinant erythropoietin was recommenced. At discharge (day 12), Hb was 10.1 g.d(L-1). The patient remains well at one year. A thoroughly, pre-planned multi-disciplinary blood conservation strategy can be used to undertake high-risk procedures.