Extreme Plasma Dilution Decreases Heparin and Protamine Cardiopulmonary Bypass Requirements: A Case Report on a Jehovah's Witness Patient

A A Case Rep. 2017 Jun 1;8(11):291-293. doi: 10.1213/XAA.0000000000000493.

Abstract

The primary focus of cardiopulmonary bypass management in Jehovah's Witness patients is the need to conserve blood. A consequence of these strategies inevitably results in hemodilution that is frequently extreme enough to dilute clotting factors and potentially impair coagulation. The purpose of this case report is to demonstrate that a hemodiluted patient requires less heparin to sustain anticoagulation and less protamine to reverse heparin at cardiopulmonary bypass termination. Patient harm may ensue unless the effects of extreme hemodilution are recognized.

Publication types

  • Case Reports

MeSH terms

  • Anticoagulants / administration & dosage*
  • Blood Coagulation / drug effects*
  • Blood Loss, Surgical / prevention & control
  • Blood Transfusion*
  • Cardiac Surgical Procedures* / adverse effects
  • Cardiopulmonary Bypass* / adverse effects
  • Hemodilution*
  • Heparin / administration & dosage*
  • Heparin Antagonists / administration & dosage*
  • Humans
  • Jehovah's Witnesses*
  • Postoperative Hemorrhage / blood
  • Postoperative Hemorrhage / etiology
  • Postoperative Hemorrhage / prevention & control
  • Protamines / administration & dosage*
  • Religion and Medicine*
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Treatment Refusal*

Substances

  • Anticoagulants
  • Heparin Antagonists
  • Protamines
  • Heparin