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Fremdblutfreier kardiopulmonaler Bypass bei vier Angehörigen der Religionsgemeinschaft „Jehovas Zeugen“ mit einem Körpergewicht unter 5 kg

Transfusion-free cardiopulmonary bypass in four Jehovah’s Witness’ patients weighing less than 5 kg

  • ORIGINALARBEIT
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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Angehörige der Religionsgemeinschaft Jehovas Zeugen lehnen Bluttransfusionen aufgrund ihrer Interpretation der Bibel meist grundsätzlich ab. Selbst Retransfusionen autologen Blutes sind ihnen untersagt, sobald das Blut ihren Kreislauf verlassen hat. Daher stellen herzchirurgische Eingriffe bei Jehovas Zeugen eine außerordentliche Herausforderung für das gesamte Team dar.

Wir berichten von herzchirurgischen Eingriffen in Kombination mit kardiopulmonalem Bypass bei vier Neonaten, bzw. Säuglingen mit einem Körpergewicht von 3,1 kg, 3,5 kg, 4,2 kg und 4,5 kg ohne jegliche Transfusion von Blutkomponenten.

Bei diesen Patienten wurde das extrakorporale Kreislaufsystem modifiziert, um das Füllvolumen der Herz-Lungen-Maschine und die daraus resultierende Hämodilution zu verringern.

Eine spezielle Herz-Lungen-Maschinen-Konsole in Verbindung mit aggressiv blutsparenden Maßnahmen ermöglichte die Operation ohne Bluttransfusion. Das extrakorporale System wurde nur mit Vollelektrolytlösung gefüllt. Der kardiopulmonale Bypass wurde in Normothermie oder in moderater Hypothermie durchgeführt. Keiner dieser Patienten erhielt Bluttransfusionen oder Blutprodukte während des stationären Behandlungszeitraumes.

Summary

Jehovah’s Witnesses reject blood transfusions on the grounds of their literal interpretation of passages of the Bible. In accordance with this belief, Jehovah’s Witnesses feel that it is also forbidden to retransfuse autologous blood that has been separated from their own circulatory system. Thus, performing cardiac surgery in pediatric Jehovah’s Witness patients is a great challenge for the surgical team.

We report the use of cardiopulmonary bypass (CPB) during open-heart surgery in four patients with body weights of 3.1 kg, 3.5 kg, 4.2 kg and 4.5 kg, respectively, without transfusion of blood components. To reduce the risk of surgery in these patients, a very small extracorporeal circuit was designed to decrease the amount of priming volume and thereby the degree of hemodilution. A dedicated pediatric heart-lung machine console with remote pump heads and intensive blood conservation efforts allowed the operation without the use of donor blood. The CPB circuits were primed with crystalloid solution only. The procedures were performed in normothermia or in moderate hypothermia. The patients did not receive any blood or blood products during their entire hospital stay.

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Authors and Affiliations

  1. Deutsches Herzzentrum Berlin, Kardiotechnik, Augustenburger Platz 1, 13353, Berlin, Germany

    W. Böttcher ECCP, F. Schulz, E. Gutsch, M. Hübler, A. Koster, M. Redlin, V. Alexi-Meskishvili, H. Kuppe, F. Berger & R. Hetzer

Authors
  1. W. Böttcher ECCP
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  2. F. Schulz
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  3. E. Gutsch
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  4. M. Hübler
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  5. A. Koster
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  6. M. Redlin
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  7. V. Alexi-Meskishvili
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  8. H. Kuppe
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  9. F. Berger
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  10. R. Hetzer
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Correspondence to W. Böttcher ECCP.

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Böttcher, W., Schulz, F., Gutsch, E. et al. Fremdblutfreier kardiopulmonaler Bypass bei vier Angehörigen der Religionsgemeinschaft „Jehovas Zeugen“ mit einem Körpergewicht unter 5 kg. Z Herz- Thorax- Gefäßchir 20, 181–188 (2006). https://doi.org/10.1007/s00398-006-0546-0

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  • DOI: https://doi.org/10.1007/s00398-006-0546-0

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