Outcome of Patients Who Refuse Transfusion After Cardiac Surgery

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Abstract
Red blood cells (RBCs) not only are in short supply but are also associated with increased morbidity and reduced survival after cardiac surgery.1-3 Jehovah's Witness patients (Witnesses) hold beliefs that disallow blood product transfusion and therefore offer a natural experiment in severe blood conservation. Their beliefs encourage the use of a number of blood conservation practices, including preoperative use of erythropoietin and iron and B-complex vitamins, hemoconcentration, and minimal crystalloid use; intraoperative use of antifibrinolytics and cell-saver and smaller cardiopulmonary bypass circuits; and postoperative liberal use of additional operation for bleeding along with tolerance of low hematocrit levels postoperatively. Although some of these practices may be beneficial to all cardiac surgical patients, others are associated with well-documented morbidity,4-6 and their effect on long-term survival is uncertain.

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