Combined Closed-circuit Acute Normovolemic Hemodilution and Deliberate Hypotension in a Jehovah’s Witness: A Case Report

Abstract

Aims: To enlighten both clinicians and Jehovah’s Witness patients on closed-circuit acute normovolemic hemodilution (ANH) and deliberate hypotension (DH) as safe and acceptable blood conservation strategies. Case Presentation: A 32 yr old male Jehovah’s Witness patient was scheduled for nephro-lithotomy on account a right nephrolithiasis (Staghorn calculus). He was fit and young weighing 76 kg with packed cell volume of 34%. The anticipated blood loss during the surgery was 1500 ml or more, hence we decided to use combined closed-circuit ANH and DH. These combined strategies were accepted by the patient; they minimized blood loss to only 400 mls and provided a good operating field visibility. Discussion: Several blood conservation strategies have been developed and accepted by Jehovah’s Witness patients provided the blood circulation circuit is not broken. Our resident doctor and patient were not initially aware of the acceptability of ANH by the Jehovah’s witness. Blood conservation strategies could be used either singly or in combination, our patient was suitable for both. Conclusion: Combined closed-circuit ANH and DH are safe and acceptable to Jehovah’s witness patients.