epoetin-alfa and Scoliosis

Topics: Adolescent; Anesthesia, General; Blood Loss, Surgical; Blood Transfusion, Autologous; Bloodless Medical and Surgical Procedures; Child; Epoetin Alfa; Female; Hematinics; Humans; Hypotension; Jehovah's Witnesses; Retrospective Studies; Scoliosis

A retrospective review.. To review the effectiveness of blood conservation techniques in the spinal fusion of patients that refuse blood transfusion; specifically the Jehovah's witnesses population.. Spinal surgery can be challenging in patients refusing blood transfusion. There is paucity in the literature examining blood conservation techniques in spinal surgery.. The radiographic and medical records of 19 Jehovah's witnesses patients who underwent spinal deformity surgery at a single institution between 2000 and 2003 were reviewed. Patients were assessed for excessive blood loss (EBL), deformity correction, operative time, perioperative complications, and hospital stay. At latest follow-up (mean, 40 months; range, 8-76) the patients were examined for radiographic fusion, progression and complications.. Spinal fusion was attempted in 19 patients, with a mean age of 17 years (range, 10-36 years). All 19 patients were identified through the "Bloodless Surgery Program." Hypotensive anesthesia, hemodilution, and cell saver was employed for all 19 cases. Erythropoietin with supplemental iron was used in 15 patients. Aprotinin was used in 3 patients. EBL and blood returned by cell saver averaged 855 and 341 mL, respectively. Operative times average 315 minutes. The average drop in hemoglobin from after surgery was 3.1 g/dL. There were 2 intraoperative complications: (i) transient loss of somatosensory evoked potential/motor evoked potential signals; and (ii) one surgery abandoned due to EBL. The average spinal deformity correction was 58%. There were 3 postoperative complications, none related to their refusal of a transfusion. 17 patients were available for radiographic and clinic follow-up of at least 24 months. All displayed radiographic fusion without progression.. These blood conservation techniques allow satisfactory completion of deformity surgery on those patients not willing to be transfused and without major anesthetic or medical complications.

Topics: Adolescent; Adult; Blood Loss, Surgical; Blood Transfusion; Child; Epoetin Alfa; Erythropoietin; Female; Follow-Up Studies; Humans; Jehovah's Witnesses; Kyphosis; Male; Radiography; Recombinant Proteins; Retrospective Studies; Scoliosis; Spinal Fusion; Treatment Refusal; Young Adult

To describe the successful perioperative hemostatic management of a Jehovah's Witness patient with hemophilia B and anaphylactic inhibitors to factor IX, undergoing scoliosis surgery.. A 14 (1/2)-yr-old boy with severe hemophilia B who had a history of anaphylactic inhibitors to factor IX was scheduled to undergo corrective scoliosis surgery. He was initially started on epoetin alfa and iron supplementation to maximize preoperative red cell mass. Additionally, he was placed on a desensitization protocol of recombinant coagulation factor IX (rFIX) and was then treated with activated recombinant coagulation factor VII (rFVIIa) during the postoperative period. Tranexamic acid was given concomitantly. The intraoperative blood loss was approximately 350 mL. The nadir hemoglobin concentration was 111 g.L(-1) on postoperative days one and two. On postoperative day 11, the patient was stable and discharged home with a hemoglobin of 138 g.L(-1). He did not require blood transfusion and no adverse events were observed.. The use of rFIX, rFVIIa, erythropoetin, iron, and tranexamic acid before, during and after scoliosis surgery may be a viable and safe option for hemophilia patients with inhibitors, who refuse blood products.

Topics: Adolescent; Antifibrinolytic Agents; Blood Loss, Surgical; Dietary Supplements; Epoetin Alfa; Erythropoietin; Factor IX; Factor VII; Follow-Up Studies; Hematinics; Hemoglobins; Hemophilia B; Humans; Iron; Jehovah's Witnesses; Male; Recombinant Proteins; Scoliosis; Trace Elements; Tranexamic Acid

Topics: Blood Loss, Surgical; Blood Transfusion, Autologous; Child; Cost-Benefit Analysis; Epoetin Alfa; Erythropoietin; Hematinics; Humans; Length of Stay; Recombinant Proteins; Scoliosis; Spine