J Korean Assoc Oral Maxillofac Surg.  2011 Feb;37(1):9-14. 10.5125/jkaoms.2011.37.1.9.

Oral cancer resection and reconstruction without blood transfusion by using recombinant human erythropoietin

• Kim CH
• Lee CH

• KMID: 2189800
• DOI: http://doi.org/10.5125/jkaoms.2011.37.1.9

Abstract

Recently, the population of patients who refuse transfusion has increased for both religious and non-religious reasons, even in life threatening emergency situations. Their refusal has highlighted the need to develop nonblood transfusion surgery techniques to decrease the risk from blood transfusions. A 57-year woman with an ulcerative lesion on the gingiva of the right upper molar area visited the department of oral and maxillofacial surgery in Dankook University Dental Hospital. After a preliminary evaluation, the patient was diagnosed with squamous cell carcinoma. As she refused blood transfusion during surgery for religious reasons, surgery was planned using recombinant human erythropoietin (rHuEPO) without a blood transfusion. The patient underwent a partial maxillectomy, supraomohyoid neck dissection, free radial forearm flap and split thickness skin graft under general anesthesia. rHuEPO and iron were used before and after surgery. The hemoglobin/hematocrit (Hb/Hct) level, iron (Fe) and total iron-binding capacity (TIBC) were assessed. The patient recovered completely without any blood transfusions. rHuEPO is a viable alternative for patients with religious objections to receiving blood transfusions.

Keyword

Recombinant erythropoietin; Blood transfusion; Mouth neoplasms

MeSH Terms

Anesthesia, General
Blood Transfusion
Carcinoma, Squamous Cell
Disulfiram
Emergencies
Erythropoietin
Female
Forearm
Gingiva
Humans
Iron
Molar
Mouth Neoplasms
Neck Dissection
Skin
Surgery, Oral
Transplants
Ulcer
Disulfiram
Erythropoietin
Iron

Figure

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  Fig. 1. Intraoral view of gingival lesion on maxilla, showing ulcerative lesion 2×3 cm diameter.

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  Fig. 2. Coronal and axial MRI (contrast-enhanced T1-weighted) showing soft tissue mass on right upper buccal mucosa and right hard palate.(MRI: magnetic resonance imaging)

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  Fig. 3. F18-FDG-PET showing uptake of FDG on right upper gingiva area.(F18-FDG-PET: F18-fluorodeoxyglucose positron emission tomography)

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  Fig. 4. Recombinant human erythropoietin 4,000 unit/0.4 mL.

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  Fig. 5. Intraoperative view of case. A. Incision line for supraomohyoid neck dissection. B. Partial maxillectomy. C. Application of free radial forearm flap. D. Split thickness skin graft.

Reference

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