A 66-year-old woman who was a Jehovah’s Witness had massive lower gastrointestinal bleeding and subsequent hypovolemic shock, necessitating a subtotal colectomy. During the postoperative period, her hemoglobin level decreased to a low of 2.6 g/dL, prolonging her dependence on mechanical ventilation. Prudent perioperative care resulted in a successful outcome. Blood-conserving techniques are indispensable in the management of Jehovah’s Witnesses who have massive blood loss. Maximizing oxygen transport, minimizing blood loss, using a cell saver when permissible, providing optimal ventilatory support, performing tracheostomy early if prolonged mechanical ventilation is expected, and augmenting hemoglobin production with administration of iron and erythropoietin are techniques that can facilitate successful outcome in patients who refuse blood transfusion.
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1 March 2011
Cases of Note|
March 01 2011
Emergency Subtotal Colectomy in a Jehovah’s Witness With Massive Lower Gastrointestinal Bleeding: Challenges Encountered and Lessons Learned
Shankar R. Raman, MD, MRCS;
Shankar R. Raman is a resident, Vellore S. Parithivel is an attending surgeon, and John M. Cosgrove is chairman and program director, Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York
Corresponding author: Shankar R. Raman, md, mrcs, Department of Surgery, Bronx-Lebanon Hospital Center, 1650 Selwyn Ave, Ste 4A, Bronx, NY 10457 (e-mail: [email protected]).
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Vellore S. Parithivel, MD;
Vellore S. Parithivel, MD
Shankar R. Raman is a resident, Vellore S. Parithivel is an attending surgeon, and John M. Cosgrove is chairman and program director, Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York
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John M. Cosgrove, MD
John M. Cosgrove, MD
Shankar R. Raman is a resident, Vellore S. Parithivel is an attending surgeon, and John M. Cosgrove is chairman and program director, Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York
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Am J Crit Care (2011) 20 (2): 176–178.
Citation
Shankar R. Raman, Vellore S. Parithivel, John M. Cosgrove; Emergency Subtotal Colectomy in a Jehovah’s Witness With Massive Lower Gastrointestinal Bleeding: Challenges Encountered and Lessons Learned. Am J Crit Care 1 March 2011; 20 (2): 176–178. doi: https://doi.org/10.4037/ajcc2011498
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