LETTER
Management of the Severely Anemic Jehovah's Witness
Amin U. Haq
15 July 1993 | Volume 119 Issue 2 | Pages 169-170
TO THE EDITOR:
In their comprehensive and very informative article on the management of severely anemic Jehovah's Witness patients, Mann and colleagues [1] mentioned desmopressin to reduce intraoperative and perioperative blood loss. Another drug, aprotinin, might be useful in such circumstances. Aprotinin has been used in heart surgery because it decreases blood loss and transfusion requirements by as much as 80% during cardiopulmonary bypass [2]. It probably acts by inhibiting kallikrein [3]. Decreased production of kallikrein results in decreased factor XIIa generation, which in turn leads to diminished tissue plasminogen activator production [4]. In addition, aprotinin is a serine protease inhibitor and thus directly neutralizes plasmin [3]. The net result of decreased production and enhanced destruction of plasmin is a powerful antifibrinolytic effect. Furthermore, during cardiopulmonary bypass, aprotinin preserves platelet function by preventing the stripping of platelet Ib receptor by enzymes such as plasmin, elastase, and calpain [5].
These actions suggest that aprotinin may help Jehovah's Witnesses undergoing cardiac surgery and those who suffer from bleeding due to hyperfibrinolysis.
1. Mann MC, Votto J, Kambe J, McNamee MJ. Management of severely anemic patient who refuses transfusion: lessons learned during the care of a Jehovah's Witness. Ann Intern Med. 1992; 117:1042-8.
2. Royston D, Bidstrup BP, Taylor KM, Sapsford RN. Effect of aprotinin on need for blood transfusion after repeat open-heart surgery. Lancet. 1987; 2:1289-91.
3. Fritz H, Wunderer G. Biochemistry and applications of aprotinin, the kallikrein inhibitor from bovine organs. Drug Res. 1983; 33:479-94.
4. Hunt BJ, Cottam S, Segal H, Ginsburg R, Potter D. Inhibition by aprotinin of tPA-mediated fibrinolysis during orthotopic liver transplantation. Lancet. 1990; 336:381.
5. van Oeveren W, Jansen NJ, Bidstrup BP, Royston D, Westaby S, Neuhof H, et al. Effect of aprotinin on hemostatic mechanisms during cardiopulmonary bypass. Ann Thorac Surg. 1987; 44:640-5.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Top
References
Article
