Mencia Marlon M, Beharry Allan, Hernandez Cruz Pedro P
Department of Clinical Surgical Sciences, The University of the West Indies, St. Augustine, TTO.
Department of Surgery, Port of Spain General Hospital, Port of Spain, TTO.
Cureus. 2021 Jun 19;13(6):e15761. doi: 10.7759/cureus.15761. eCollection 2021 Jun.
Revision total hip arthroplasty (THA) is a major reconstructive procedure traditionally associated with significant blood loss. Jehovah's Witnesses (JW) do not accept blood or blood product transfusions because of their religious beliefs. When confronted with a JW patient requiring a complex arthroplasty procedure, surgeons face moral and ethical questions and may be reluctant to perform surgery. A successful outcome depends on several factors including surgical and anesthetic expertise, a range of revision implants, and a multimodal blood management protocol. While these resources are readily available in a developed country, in many of the developing Caribbean islands, the healthcare system is underfunded and under-resourced. Here, we describe our experience performing a revision THA on a JW patient in the Caribbean. Through this case report, we aim to illustrate our approach to blood management by exploring the fundamental elements that were employed in a low-resource setting. We believe that the extrapolation of these crucial principles to the broader category of primary arthroplasty in the general population can be used to reduce the rate of blood transfusion, increase access to surgery, and improve outcomes.
翻修全髋关节置换术（THA）是一种主要的重建手术，传统上与大量失血相关。耶和华见证人（JW）由于其宗教信仰不接受输血或血液制品输血。当面对需要进行复杂关节置换手术的JW患者时，外科医生面临道德和伦理问题，可能不愿进行手术。成功的结果取决于几个因素，包括手术和麻醉专业知识、一系列翻修植入物以及多模式血液管理方案。虽然这些资源在发达国家很容易获得，但在许多加勒比发展中岛屿，医疗保健系统资金不足且资源匮乏。在此，我们描述我们在加勒比地区为一名JW患者进行翻修THA的经验。通过本病例报告，我们旨在通过探讨在资源匮乏环境中采用的基本要素来说明我们的血液管理方法。我们相信，将这些关键原则推广到普通人群中更广泛的初次关节置换类别，可以用于降低输血率、增加手术可及性并改善结果。
