Erythropoietin and Desmopressin Obviated Transfusion in a Thromboasthenic Jehovah's Witness Undergoing Scoliosis Surgery

Abstract

A 13-year-old female Jehovah's Witness with thromboasthenia was scheduled for scoliosis surgery. To reduce the risk of heterologous transfusion, she was given erythropoietin for 2 weeks preoperatively. Bleeding time and platelet dysfunction normalized during erythropoietin treatment, but the hemoglobin concentration increased only marginally. Desmopressin and tranexamic acid were given as cover for surgery. Blood loss was less than that in the average scoliosis patient, 1,490 ml as compared to 2,740 ml, and no heterologous transfusion was given. Erythropoietin may thus be given preoperatively, not only to increase the hemoglobin concentration, but also to improve the platelet function in thromboasthenic pa tients.

Keywords

Key Words: Erythropoietin Thromboasthenia Jehovah's Witness.

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References

Benoni G. , Lethagen S. , Willner S. Fibrinolysis and fibrinolytic inhibition during scoliosis surgery—a method to reduce blood loss. Acta Orthop Scand 1994;65(suppl 260):94.

Benson KT The Jehovah's Witness patient: considerations for the anesthesiologist . Anesth Analg 1989;69;647.

Cobb JR

Outline for study of scoliosis. Amer Academy of

Orthop Surg 1948;5:261-75.

Lethagen S. , Kling S. New bleeding time devices with retractable blades in children, healthy volunteers and patients with prolonged bleeding time. Thromb Haemost 1993;70: 595.

Lethagen S. , Nilsson IM DDAVP induced enhancement of platelet retention. Its dependence on platelet-von Willebrand factor and the platelet receptor GPIIb/IIIa. Eur J Haematol 1992;49:7.

Graber SE , Krantz SB Erythropoietin and the control of red cell production. Ann Rev Med 1978;29:51.

Goodnough LT , Rudnick S. , Price TH , Ballas SK , Collins ML , Crowley JP , Kosmin M. , Kruskall MS , Lenes BA , Menitove JE , Silberstein LE , Smith KJ , Wallas CH , Abels R. , Tress MV Increased preoperative collection of autologous blood with recombinant human erythropoietin therapy . N Engl J Med 1989;321:1163.

Canadian Orthopedic Perioperative Erythropoietin Study Group. Effectiveness of perioperative recombinant human erythropoietin in elective hip replacement. Lancet 1993 ;341: 1227.

Moia M. , Mannucci PM , Vizzotto L. , Casati S. , Cattaneo M. , Ponticelli C. Improvement in the haemostatic defect of uraemia after treatment with recombinant human erythropoietin. Lancet 1987 ;ii:1227.

10.

Roger SD , Piper J. , Tucker B. , Raine AE , Baker LR , Kovacs IB Enhanced platelet reactivity with erythropoietin but not following transfusion in dialysis patients. Nephrol Dial Transplant 1993;8:213.

11.

Mazerska M. , Pawlak K. , Azzadin A. , Malyszko J. , Mysliwiec M. , Buczko W. Platelet aggregation during the recombinant human erythropoietin (rHuEPO) treatment of patients with uremia. Pol Arch Med Wewn 1992;88:230.