Mohamed Qandil, Rabee Tawel, Ans Alamami, Hani Jaouni, Ibrahim Fawzy Hassan, Ayman El-Menyar, Ahmed Labib Shehatta
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引用次数: 0
Abstract
Background: Severe coronavirus disease 2019 (COVID-19) infection can lead to severe acute respiratory syndrome for which extracorporeal membrane oxygenation (ECMO) could be used in selected cases. Most Jehovah's witnesses (JWs) do not accept transfusion of blood and/or blood products. The use of ECMO for the management of JWs during the pandemic was challenging.
Case report: We present a case of a JW with severe COVID-19 infection and multiple organ failure necessitating ECMO support for 20 days. We discuss the management challenges in patients who do not accept blood transfusions. A significant drop in the patient's haemoglobin and platelet count was observed throughout ECMO duration. An anti-coagulation-free ECMO circuit was maintained, and we did not observe any major circuit or patient complications.
Conclusion: Management strategies to minimize blood loss, avoid bleeding, augment haemoglobin production, maintain ECMO circuit integrity without systemic anticoagulation, and reduce blood loss during ECMO decannulation are helpful in the management of JW followers on ECMO. We recommend treatment in such a situation at experienced centres with the involvement of a haematologist within an interprofessional team.
Learning points: Management of patients who are Jehovah's witnesses, who do not accept blood transfusion is challenging.Conservative transfusion strategies are feasible on selected patients supported by extracorporeal membrane oxygenation.Transfusion thresholds should be dynamic and reviewed daily.Mitigation of blood loss, rationalization of blood tests, and anticoagulation help reduce the need for transfusion.Transfusion targets and guidelines need revision, and it is best to adopt patient-specific targets tailored to each patient's needs.
期刊介绍：
The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from 33 European countries. The Journal''s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field. EJCRIM welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight and/or contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors). The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.
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