Original article

Blood Transfusion - 2 2022 (March-April)

Peri-operative blood management of Jehovah’s Witnesses undergoing cytoreductive surgery for advanced ovarian cancer

Authors

Key words: bloodless surgery, ferric carboxymaltose, Jehovah’s Witnesses, ovarian cancer, perioperative blood management
Publication Date: 2021-02-25

Abstract

Background - The aim of this study was to evaluate the efficacy and feasibility of a peri-operative bloodless medicine and surgery (BMS) protocol in reducing severe post-operative anaemia (haemoglobin [Hb] <7 g/dL) in Jehovah’s Witnesses undergoing cytoreductive surgery for advanced epithelial ovarian cancer.
Materials and methods - This was a single-institution retrospective study enrolling Jehovah’s Witnesses who underwent elective bloodless surgery for advanced epithelial ovarian cancer between October 2017 and April 2020. All patients followed a standardised bloodless medicine and surgery protocol based on ferric carboxymaltose and erythropoietin if indicated.
Results - Twenty-five patients with a mean age of 61.7 years (range, 35-80) were enrolled. Pre-operatively, ten patients (40%) were mildly anaemic (mean Hb of 10.2 g/dL [range, 9.2-11.4]) and received ferric carboxymaltose. Only four (16%) patients had severe anaemia after surgery (mean Hb of 6.1 g/dL [range, 4.1-6.9]) and received ferric carboxymaltose and erythropoietin. Compared to patients with a post-operative Hb ≥7 g/dL, those with Hb <7 g/dL had higher mean body mass index (25.8±1.8 vs 30.7±1.8 kg/m2; p<0.001), mean baseline CA125 (236.1±184.5 vs 783.7±273.5 IU/mL; p<0.001), median surgical complexity score (2 vs 10; p<0.001), and rate of post-operative complications (14.3 vs 100%; p<0.001). Moreover, these patients had a longer mean operating time (3.4±0.6 vs 5.5±0.4 h; p<0.001), duration of stay in hospital (5.5±0.7 vs 24.0±9.8 days; p<0.001), and time to adjuvant chemotherapy  (27.2±2.6 vs 65.3±13.4 days; p<0.001).
Discussion - The use of a multidisciplinary bloodless medicine and surgery protocol is safe and effective in reducing the rate of severe post-operative anaemia and improving surgical and oncological outcomes of Jehovah’s Witnesses with advanced epithelial ovarian cancer. Further large-scale, prospective studies are required to confirm these data.

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Authors

Innocenza Palaia - Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy

Giuseppe Caruso - Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy

Violante Di Donato - Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy

Giorgia Perniola - Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy

Giancarlo Ferrazza - Department of Immunohaematology and Transfusion Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy

Enrico Panzini - Department of Immunohaematology and Transfusion Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy

Maria Scudo - Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy

Anna Di Pinto - Department of Immunohaematology and Transfusion Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy

Ludovico Muzii - Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy

Pierluigi Benedetti Panici - Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy

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