A case of a multiply injured hemodialysis patient treated without blood transfusion

Abstract

A The patient was a 60-year-old man, who was undergoing maintenance dialysis. He was admitted following a traffic accident. Diagnostic imaging revealed fractures of the sternum, ribs, facial bones, mandibula, pelvis, right lumbar transverse process, right fibula, and left radius. Bilateral hemothorax, lung contusion, and right pneumothorax were also found. His Injury Severity Score (ISS) was 29. Although he suffered from hemorrhagic shock, the patient him-self and his family refused blood transfusion for religious reasons. Circulation dynamics were maintained by transfusion of albumin and other infusions for which their consent could be obtained. The patient’s hemoglobin level, which was 10.3g/dL on admission because of renal anemia, gradually fell to 3.5g/dL on day 54 after admission. All fractures were treated conservatively because of the anemia. During treatment, he had heart and respiratory failure. This was accompanied by multiple complications, such as chronic subdural hematoma, cerebral infarction, and shunt occlusion. However, his general state improved under intensive treatment, and his anemia also returned to its pre-ac-cident level. We treated a case of a multiply injured hemodialysis patient who could not receive blood transfusion for religious reasons. It is necessary to discuss more about the religious refusal of blood transfusion during emergency treatment.