Major liver surgery in a Jehovah's Witness patient: challenges for safe surgery

WY Lim, L Loh, SR Desai, SL Tien, BK Goh, P Wong
2019 Southern African Journal of Anaesthesia and Analgesia  
Jehovah's Witnesses presenting for major surgery run the risk of major bleeding, which is complicated by the refusal to accept blood transfusion. We present a case of a 63-year-old woman, a Jehovah's Witness, who was diagnosed with hepatocellular carcinoma and advised for curative laparoscopic liver segmentectomy. Due to the risk of significant intraoperative haemorrhage, her perioperative care was coordinated in a multidisciplinary manner. Informed consent requires the physician to advise on
more » ... e material risks of undertaking major surgery without blood transfusion and the possible alternatives. Conflicting ethical issues of patient autonomy and beneficence related to refusal of blood products also arise. Perioperative strategies to minimise blood loss, maximise haematopoiesis and tolerance of anaemia to facilitate safe surgery in such patients are also presented. Written patient consent obtained.
doi:10.36303/sajaa.2019.25.3.2220 fatcat:lntbtj3pgnas5nkkdjgvmeaps4