Jehovah's Witnesses do not allow transfusion of allogeneic or predonated autologous blood. Van Son et al summarized several strategies that allow cardiac surgery with cardiopulmonary bypass in infants without requiring blood transfusion. The authors are from the University of California San Francisco.


Agents to enhance erythropoiesis:

(1) Administer recombinant erythropoietin before surgery if the hematocrit is <= 38%.

(2) Oral iron supplementation if iron deficient or to replace blood loss.


Reduce unnecessary blood loss:

(1) Avoid cardiac catheterization when possible.

(2) Use an religiously acceptable blood salvage system.



(1) Delay heparin reversal after bypass until all active bleeding sites have been controlled.

(2) Consider use of aprotonin (proteinase inhibitor that reduces fibrinolysis and plasmin formation) during the operation.


Surgical technique:

(1) Use low-energy electrocautery in the chest wall, pericardial and great vessel dissections.

(2) Avoid deep levels of hypothermia (reduces the obligatory duration of rewarming).


Operation of cardiopulmonary bypass pump:

(1) Administer minimal prebypass fluid administration.

(2) Reduce the priming volume by minimizing the bypass machine circuit volume.

(3) Use moderate pump flow rates and cardiotomy suction to minimize blood cell destruction.

(4) Use ultrafiltration to remove excess water.

(5) Gradual return of the entire volume of the residual perfusate from all components of the bypass pump system.


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