Perioperative challenges in the care of the Jehovah's Witness: a case report

Same day admissions for surgery represent a growing portion of the operating room workload. Vigilance during preanesthetic evaluation and standards of preoperative preparation must be maintained for patients who are undergoing elective procedures. This case study reports the preanesthetic evaluation and perioperative management of a Jehovah's Witness who bled to a hematocrit of 9.0% during a myomectomy. The discussion considers the need for preoperative preparation and conservation of circulating red blood cells. Perioperative management modalities to conserve red blood cells including deliberate, controlled hypotension; autotransfusion; and normovolemic and hypervolemic hemodilution, are presented.