Major liver surgery in a Jehovah’s Witness patient: challenges for safe surgery

  • Wan Yen Lim Singapore General Hospital
  • Leonard Loh Singapore General Hospital
  • Suneel Ramesh Desai Singapore General Hospital
  • Sim Leng Tien Singapore General Hospital
  • Brian Kim Goh Singapore General Hospital
  • Patrick Wong Singapore General Hospital
Keywords: Jehovah Witness, perioperative anaemia, patient blood management, consent, general anaesthesia

Abstract

Jehovah’s Witnesses presenting for major surgery run the risk of major bleeding, which is complicated by the refusal to accept blood transfusion. We present a case of a 63-year-old woman, a Jehovah’s Witness, who was diagnosed with hepatocellular carcinoma and advised for curative laparoscopic liver segmentectomy. Due to the risk of significant intraoperative haemorrhage, her perioperative care was coordinated in a multidisciplinary manner. Informed consent requires the physician to advise on the material risks of undertaking major surgery without blood transfusion and the possible alternatives. Conflicting ethical issues of patient autonomy and beneficence related to refusal of blood products also arise. Perioperative strategies to minimise blood loss, maximise haematopoiesis and tolerance of anaemia to facilitate safe surgery in such patients are also presented. Written patient consent obtained.

Author Biographies

Wan Yen Lim, Singapore General Hospital

Department of Anaesthesiology, Singapore General Hospital, Singapore

Leonard Loh, Singapore General Hospital

Department of Anaesthesiology, Singapore General Hospital, Singapore

Suneel Ramesh Desai, Singapore General Hospital

Department of Anaesthesiology, Singapore General Hospital, Singapore

Sim Leng Tien, Singapore General Hospital

Department of Haematology, Singapore General Hospital, Singapore

Brian Kim Goh, Singapore General Hospital

Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore

Patrick Wong, Singapore General Hospital

Department of Anaesthesiology, Singapore General Hospital, Singapore

Published
2019-07-08
Section
Case Studies