透析中のエホバの証人患者に対して冠状動脈バイパス術を行った1例

Off-pump Coronary Artery Bypass Grafting in Jehovah’s Witness Patient on Hemodialysis；Report of a Case

はじめに　心臓手術では術中にheparinを使用するため出血が多く，人工心肺の使用や低体温など血液凝固系に与える影響も大きく，輸血が必要となることが多い．さらに透析患者は貧血・出血傾向もある．われわれは透析中のエホバの証人患者に対して冠状動脈バイパス術（CABG）を行ったので報告する．

Cardiac surgery in Jehovah’s witnesses is challenging due to their refusal of blood transfusion. Furthermore, dialysis patients often suffer from anemia and are also prone to bleeding. We performed off-pump coronary artery bypass grafting （CABG）［OPCAB］ on a Jehovah’s witness male patient on hemodialysis. His preoperative hemoglobin level was around 10.0 g/dl. We used cell saver-collected blood as much as possible during operation. His postoperative course was uneventful with the lowest hemoglobin level of 7.2 g/dl using iron supplements and erythropoietin. This case indicates that intraoperative blood salvage and perioperative management of anemia make OPCAB without blood transfusion possible even in Jehovah’s witness hemodialysis patients, when their preoperative hemoglobin levels are maintained greater than 10.0 g/dl.