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Major surgery in an osteosarcoma patient refusing blood transfusion: case report.

Dhanoa A, Singh VA, Shanmugam R, Rajendram R - World J Surg Oncol (2010)

Bottom Line: This 16-year-old girl presented with osteosarcoma of the right proximal tibia requiring proximal tibia resection, followed by endoprosthesis replacement.She was successfully treated with neoadjuvant chemotherapy and surgery with the support of haematinics, granulocyte colony-stimulating factor, recombinant erythropoietin and intraoperative normovolaemic haemodilution.This case illustrates the importance of maintaining effective, open communication and exploring acceptable therapeutic alternative in the management of these patients, whilst still respecting their beliefs.

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Affiliation: Jeffrey Cheah School of Medicine and Health Sciences, Monash University Sunway Campus, Malaysia. amreeta.dhanoa@med.monash.edu.my

ABSTRACT
We describe an unusual case of osteosarcoma in a Jehovah's Witness patient who underwent chemotherapy and major surgery without the need for blood transfusion. This 16-year-old girl presented with osteosarcoma of the right proximal tibia requiring proximal tibia resection, followed by endoprosthesis replacement. She was successfully treated with neoadjuvant chemotherapy and surgery with the support of haematinics, granulocyte colony-stimulating factor, recombinant erythropoietin and intraoperative normovolaemic haemodilution. This case illustrates the importance of maintaining effective, open communication and exploring acceptable therapeutic alternative in the management of these patients, whilst still respecting their beliefs.

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Resected tibia shown with endoprosthesis used to replace the defect.
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Figure 3: Resected tibia shown with endoprosthesis used to replace the defect.

Mentions: A standard approach was used and the proximal tibia was resected, followed by proximal tibia endoprosthesis replacement. The resected tumour bone and the endoprosthesis used to replace the defect are shown in Figure 3 and Figure 4. Meticulous attention to haemostasis was of paramount importance. A tourniquet was used during the surgery which was released on and off to secure haemostasis. The patient was operated in Trendelenburg position to minimize blood loss due to high venous pressure when the tourniquet was released. Cell saver technique was not used because of possibility of contamination with malignant cells.


Major surgery in an osteosarcoma patient refusing blood transfusion: case report.

Dhanoa A, Singh VA, Shanmugam R, Rajendram R - World J Surg Oncol (2010)

Resected tibia shown with endoprosthesis used to replace the defect.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2991319&req=5

Figure 3: Resected tibia shown with endoprosthesis used to replace the defect.
Mentions: A standard approach was used and the proximal tibia was resected, followed by proximal tibia endoprosthesis replacement. The resected tumour bone and the endoprosthesis used to replace the defect are shown in Figure 3 and Figure 4. Meticulous attention to haemostasis was of paramount importance. A tourniquet was used during the surgery which was released on and off to secure haemostasis. The patient was operated in Trendelenburg position to minimize blood loss due to high venous pressure when the tourniquet was released. Cell saver technique was not used because of possibility of contamination with malignant cells.

Bottom Line: This 16-year-old girl presented with osteosarcoma of the right proximal tibia requiring proximal tibia resection, followed by endoprosthesis replacement.She was successfully treated with neoadjuvant chemotherapy and surgery with the support of haematinics, granulocyte colony-stimulating factor, recombinant erythropoietin and intraoperative normovolaemic haemodilution.This case illustrates the importance of maintaining effective, open communication and exploring acceptable therapeutic alternative in the management of these patients, whilst still respecting their beliefs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Jeffrey Cheah School of Medicine and Health Sciences, Monash University Sunway Campus, Malaysia. amreeta.dhanoa@med.monash.edu.my

ABSTRACT
We describe an unusual case of osteosarcoma in a Jehovah's Witness patient who underwent chemotherapy and major surgery without the need for blood transfusion. This 16-year-old girl presented with osteosarcoma of the right proximal tibia requiring proximal tibia resection, followed by endoprosthesis replacement. She was successfully treated with neoadjuvant chemotherapy and surgery with the support of haematinics, granulocyte colony-stimulating factor, recombinant erythropoietin and intraoperative normovolaemic haemodilution. This case illustrates the importance of maintaining effective, open communication and exploring acceptable therapeutic alternative in the management of these patients, whilst still respecting their beliefs.

Show MeSH
Related in: MedlinePlus