LAPAROSCOPIC SPLENECTOMY IN A JEHOVAH-WITNESS WITH PROFOUND ANEMIA

Open surgery in a severely anemic patient may be complicated by a subs tantial blood loss from a large incision and subsequent poor wound hea ling secondary to the anemia. We report our success in performing a sp lenectomy laparoscopically in a profoundly anemic patient. A 50-year-o ld white male Jehovah's Witness who was HIV positive was referred for splenectomy after he developed profound, worsening anemia secondary to hypersplenism that was refractory to medical management. His preopera tive hemoglobin and hematocrit levels were 2.7 g/dl and 8.8%, respecti vely, but his religious beliefs precluded transfusion, A laparoscopic splenectomy by the posterior gastric approach was performed. The patie nt tolerated the surgery well and experienced no additional morbidity. On postoperative day 7, his hemoglobin and hematocrit were 6.8 g/dl a nd 22%, respectively. We conclude that laparoscopic splenectomy is an attractive procedure in a severely anemic patient who requires splenec tomy and refuses blood transfusion.