Impact of effective communication on acute type A aortic dissection management of a Jehovah’s Witness patient

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dc.contributor.author Beliaev, AM en
dc.contributor.author Luke, H en
dc.contributor.author Bergin, Colleen en
dc.contributor.author Willcox, T en
dc.contributor.author Sibal, AK en
dc.date.accessioned 2020-01-29T21:11:39Z en
dc.date.issued 2019-12 en
dc.identifier.citation ANZ Journal of Surgery 89(12):1683-1683 Dec 2019 en
dc.identifier.issn 1445-1433 en
dc.identifier.uri http://hdl.handle.net/2292/49696 en
dc.description.abstract Acute type A aortic dissection (ATAD) is a life-threatening medical condition. Emergency surgery confers the best chance of survival, but has up to 25% risk of mortality. Uncontrollable haemorrhage occurs in approximately 20% of these patients and is the third most common cause of patient death.1 Many cardiac surgeons consider refusal of blood transfusion as a contraindication to ATAD repair. We describe a Jehovah’s Witness with ATAD who refused blood transfusion, but after deliberation with the surgeon accepted platelet transfusion, the use of cell-saver and topical haemostatic agents. A 55-year-old male was airlifted to our hospital after ATAD had been diagnosed on computed tomography pulmonary angiography at his base hospital when he presented with central chest pain. The patient had stable vital sings with arterial blood pressure controlled with intravenous labetalol infusion. Blood tests revealed mild anaemia, normal platelet count, renal and liver function as well as coagulation tests results. A computed tomography aortogram demonstrated aortic dissection that extended from the aortic root to the iliac arteries. Transthoracic echocardiography showed normal systolic heart function and a trileaflet aortic valve with moderate aortic regurgitation. The patient underwent emergency ATAD repair using hypothermic circulatory arrest. The post-operative period was uncomplicated with the nadir haemoglobin concentration of 70 g/L. Surgical repair of ATAD causes significant blood loss. Only 6% of post-operative ATAD patients do not require either allogeneic red blood cell or platelet transfusion and 11% of patients require platelets transfusion alone.2 Thus, our patient had a 17% chance of not requiring allogeneic red blood cell transfusion provided platelets could be used. Our case emphasizes the importance of an effective doctor–Jehovah’s Witness patient relationship. Surg. Res. 2018; 232 en
dc.publisher Wiley en
dc.relation.ispartofseries ANZ Journal of Surgery en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights This is the pre-peer reviewed version of the following article: ANZ Journal of Surgery 89(12):1683-1683 Dec 2019, which has been published in final form at http://dx.doi.org/10.1111/ans.15505. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.rights.uri https://authorservices.wiley.com/author-resources/Journal-Authors/licensing/self-archiving.html en
dc.title Impact of effective communication on acute type A aortic dissection management of a Jehovah’s Witness patient en
dc.type Journal Article en
dc.identifier.doi 10.1111/ans.15505 en
pubs.issue 12 en
pubs.begin-page 1683 en
pubs.volume 89 en
dc.rights.holder Copyright: Royal Australasian College of Surgeons en
pubs.author-url https://rdcu.be/b0AZL en
pubs.end-page 1683 en
dc.rights.accessrights http://purl.org/eprint/accessRights/OpenAccess en
pubs.subtype Letter en
pubs.elements-id 792685 en
pubs.org-id Medical and Health Sciences en
pubs.org-id Medical Sciences en
pubs.org-id Anatomy and Medical Imaging en
pubs.record-created-at-source-date 2020-01-22 en
pubs.dimensions-id 31846564 en


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