Use of desmopressin and erythropoietin in an anaemic Jehovah's Witness patient with severely impaired coagulation capacity undergoing stentless aortic valve replacement

Cardiac surgery in Jehovah's Witness patients remains a challenge in the pr esence of concomitant congenital or acquired coagulation disorders and anae mia. We report a case of a 66-year-old female Jehovah's Witness suffering f rom severe calcified aortic valve stenosis requiring aortic valve replaceme nt. The anaemic patient suffered from concomitant platelet dysfunction and deficiency of factors V and VII due to gammopathy of immunoglobulin G. The patient was preoperatively treated with recombinant erythropoietin in combi nation with folic acid and iron, which resulted in an increase of the haema tocrit from 0.335 to 0.416 after 22 days of treatment. Haemostasis was impr oved by high dose aprotinin and additional desmopressin, which could be dem onstrated to be effective by a preoperative test. The patients intra- and p ostoperative course was uneventful, her total chest tube loss was 130 ml, a nd she was able to be discharged without the need of any blood transfusions . The beneficial properties of erythropoietin and desmopressin in Jehovah's Witness patients are discussed.