Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942005000500009
Brazilian Journal of Anesthesiology
Clinical Information

Manuseio de grave diminuição de hemoglobina em paciente jovem, testemunha de Jeová, submetido à proctocolectomia total: relato de caso

Extreme intraoperative hemodilution in Jehovah’s witness patient submitted total proctocolectomy: case report

Luiz Eduardo Imbelloni; Lúcia Beato; Arídio Ornellas; Carlos Roberto Junqueira Borges

http://dx.doi.org/10.1590/S0034-70942005000500009 Braz J Anesthesiol, vol.55, n5, p.538-545, 2005
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Resumo

JUSTIFICATIVA E OBJETIVOS: Os riscos de transfusão homóloga de sangue são bem conhecidos e alguns pacientes recusam esta transfusão por motivos religiosos. O objetivo foi relatar um caso de proctocolectomia total em Testemunha de Jeová onde o nível de hemoglobina foi de 4 g/dL. RELATO DO CASO: Paciente do sexo masculino, 17 anos, história de polipose intestinal familiar. Iniciada aos oito anos, caracterizada por sangramento. Aos 13 anos colectomia total. Aos 17 anos proctocolectomia total. Preparado com eritropoietina, ácido fólico, infusão de ferro e vitamina B12. Hemograma revelou: hemácias 4.200.000/mm³, hemoglobina 10,5 g/dL e hematócrito de 37%. Plaquetas 273.000/mm³, tempo de protrombina normal. Monitorização com PANI, oximetria de pulso, capnografia e ECG continuamente. Anestesia com propofol, sufentanil, pancurônio e enflurano em circuito fechado. Infusão de 7.000 mL de solução de Ringer com lactato e 150 mL de albumina humana a 20%. Diurese de 2.900 mL. Duração de 10 horas e 30 minutos. Na UTI Ht de 20%, hemácias 2.300.000/mm³, Hb de 4,2 g/dL e mantido com propofol e atracúrio. Exame no dia seguinte revelou: Ht de 18%, hemácias de 2.050.000/mm³, Hb de 4 g/dL. Extubado 18 horas após o término da cirurgia. Segundo dia encaminhado para o quarto. Quarto dia iniciada alimentação por via oral. Alta hospitalar no décimo dia de PO. No 30º PO Ht de 35%, hemácias de 4.000.000/mm³ e Hb de 9,5 g/dL. Seis meses após, fechamento da ileostomia. Submetido a 12 cirurgias sem transfusão sangüínea. CONCLUSÕES: Um planejamento de toda a equipe (clínico, cirurgião, anestesiologista e médicos de terapia intensiva) permite realizar procedimentos cirúrgicos associados com importantes perdas sangüíneas, sem administração de sangue.

Palavras-chave

COMPLICAÇÕES, DOENÇAS, TRANSFUSÃO

Abstract

BACKGROUND AND OBJECTIVES: Homologous blood transfusion risks are well known and some patients may refuse blood transfusions on religious grounds. This report aimed at describing a case of total proctocolectomy in Jehovah’s Witness patient with 4 g/dL hemoglobin. CASE REPORT: Male patient, 17 years old, with family history of adenomatous polyposis. The disease was manifested at eight years of age, characterized by bleeding. At 13 years of age he was submitted to total colectomy. At 17 years of age he was submitted to total proctocolectomy. Patient was prepared with erythropoietin, folic acid, infusion of iron and vitamin B12. Red blood cell count revealed He = 4,200,000/mm³, hemoglobin = 10.5 g/dL, hematocrit = 37% platelets = 273,000/mm³ and normal prothrombin time. Patient was continuously monitored with NIBP, pulse oximetry, capnography and ECG. Anesthesia was induced with propofol, sufentanil, pancuronium and enflurane in closed system. Patient received 7,000 mL lactated Ringer’s and 150 mL of 20% human albumin. Total diuresis was 2,900 mL. Surgery lasted 10 hours and 30 minutes. Patient was referred to the ICU with 20% hematocrit, 2,300,000/mm³ red cells, 4,2 g/dL hemoglobin and was maintained with propofol and atracurium. Next day evaluation revealed 18% hematocrit, 2,050,000/mm³ red cells and 4 g/dL hemoglobin. Patient was extubated 18 hours after surgery and was referred to the ward. Patient started eating four days after surgery and was discharged the 10th postoperative day. Thirty days later patient presented 35% hematocrit, 4,000,000/mm³ red cells and 9.5 g/dL hemoglobin. Six months later he returned for ileostomy closing. Patient was submitted to 12 surgeries without a single blood transfusion. CONCLUSIONS: A good planning of the whole team (clinician, surgeon, anesthesiologist, intensive care staff) allows us to perform surgical procedures associated to major blood losses without administering blood.

Keywords

COMPLICATIONS, DISEASES, TRANSFUSION

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