An 11- year-old Nguyen.G.B (28 kilograms in weight) living in District 6 Ho Chi Minh City, was diagnosed with liver tumors 6 months ago. Morning September 5, 2018 at City International Hospital, the boy underwent a successful 2.5-hour-liver tumor removal (10 cm in diameter);
Under one mind-boggling condition requested by his family that religiously he could not receive blood transfusion from any donor (not even from his family members) but himself. Our doctors’ solution was to use Cell Saver (Blood Salvage) which is a device used in surgery to collect the blood the patient loses during your surgery, cleans the blood and returns the blood back to that patient.
Team Diagnosis and Decision Making
An important Doctor-Patient meeting took place on August 31, 2018 between family members of patient Nguyen.G.B and a team of top doctors at City international Hospital: A/Prof. Dr. Nguyen Tan Cuong, A/Prof. Dr. Tran Quang Binh, Dr. Dao Thi My Van, Dr. Luc Chanh Tri, Dr. Tran Thi My Loan, Dr. Ha Thi Thanh Tuyen, Dr. Nguyen Bao Xuan Thanh and other related medical staff. Upon the patient family’s request for a surgery operating without Blood Transfusion meaning during the surgery, the patient would not be able to receive blood transfusion from any donor (not even from his family members) but himself. That explained a lot of our doctors’ concerns and hesitation, though after the team carefully diagnosed and decision making based on accurate laboratory tests, A/Prof. Dr. Nguyen Tan Cuong decided to lead the team in this surgery operation.
Before the surgery, patient was prescribed with drugs for increasing red blood cells and during surgery; patients are given alternatives to blood transfusions to ensure safety. Our doctors decided to use Cell Saver (Blood Salvage) – a device which is a different choice other than getting blood transfusions from someone else. It collects the blood you lose during your surgery, cleans the blood and returns the blood back to you. Up to 80 per cent of the red blood cells you lose during your surgery can be returned to you. This method is especially useful because it can restore enough blood needed for the body; Up to 80 per cent of the red blood cells you lose during your surgery can be returned to you as well as minimize blood loss and the need for transfusions and avoid other transfusion-related complications.
August 31, 2018 Team Diagnosis and Decision Making
August 31, 2018 Team Diagnosis with the patient at City International Hospital
According to A/Prof. Dr. Nguyen Tan Cuong: “Before City International hospital, the patient was taken to many other major hospitals seeking for life-saving treatments but the boy was sent home every single time due to not having the solution for no blood transfusion. By time, the boy’s liver tumor increased from the size of 7 to 10 centimeters in diameter. Accepting the case, we had to carefully and thoroughly consulted, explained to the patient and his family details and in-depth of the case including pros and cons, what we can do for the boy as well as all of the possibility that might come out after. At the urgent request of the patient's family, and with the physician's paramedics, our powerful team all his strength and expertise to operate this pediatric surgical treatment of liver tumors.”
Thorough preparation needed for the surgery
Morning September 5, while kids everywhere were excitedly being welcomed back to school on their first day of the new school year, our little patient Nguyen. G.B had to go through maybe the biggest surgery ever in his life of liver tumor removal. Sharing with us, Dr. Nguyen Tan Cuong expressed: "The child's eyes kept pursuing me that I had to do something despite any challenges that we might have to take. Those eyes also kept me up for several nights of thinking and finding any possible solutions. I finally decided I had to take responsibility in finding hopes for this boy, saving his life and bringing back his happiness and many others. During the surgery, we lowered his blood flow to make a cut in his liver and limited the amount of blood loss. Then we use Cell Saver to collect what he lost during surgery, rinse away unneeded fat and tissue, and then centrifuge and separate the red cells, which are then returned to him. We have investigated abdominal CT scans, there were abnormal blood vessels, prognosis during bleeding, and chances were we might be excessively losing without performing it to perfection. As a result, our surgeons went into very little details of the surgery without flaws, careful blood management; control all of the main blood vessels feeding the tumor. After 2 hours and 30 minutes, the doctor removed liver part that contains the tumor accounted for 15 % of total hepatic. At young age, the liver will proliferate rapidly to compensate for the cut. During the operation, blood loss is about 200 ml. Then we use Cell Saver to collect what he lost during surgery, rinse away unneeded fat and tissue, and then centrifuge and separate the red cells, which are then returned to him.
Surgery Operating of Pediatric Liver (Hepatic) Tumor without Blood Transfusion Morning September 5, 2018 at City International Hospital
The surgery was a success since we have very well prepared and investigated any abnormal blood vessels, utilized all the best facilities of the hospital. Typically, during anesthesia, the team has given an epidural analgesic medication so that after recovery, the baby will be less painful, recovering sooner. When a part of the liver is removal, our anesthesiologists proactively reduced blood pressure for less blood flow (about 200ml).
Life-saving success and joy among doctors, patient and family
The case was a success bringing joy to our entire team of hard working doctors. The team was speechless and just happy in silent. That Reflection on the Ethics of Medicine: Intellectual properties to save lives.
Dr. Cuong explained: "If City International Hospital refused the case, there will probably be very few or no medical facilities in Vietnam can meet the need of the patient’s family. As you can see, the patient has a terminal illness: Pediatric liver tumor without blood transfusion from any other donors, not even from family members during surgery. "
His family members were deeply appreciated, his mother said: "We are very lucky to find City International Hospital; from highly-qualified doctors to well-trained nurses and their care, explaining sincerely gives us deep belief. Our baby has successfully undergone a major surgery. Our biggest appreciation to Dr. Cuong and the entire surgical team, as well as the hospital for winning over and earned my child’s life back.”
After 34 years as one of the top surgeons in renal (kidney), hepatic (liver) and pancreatic surgeries, this is his first surgical case that Dr. Nguyen Tan Cuong performed for a Jehovah's Witness obstetric patient. “Life-threatening massive bleeding is doubtlessly one of the biggest challenges in health care, especially in patients who reject allogeneic transfusion, such as Jehovah’s Witnesses. he said. For example, if surgery involves a rupture of the liver, rupture of the spleen, without blood transfusion, no fluid can be replaced which would put the patient’s life on the line. Especially have we completed our mission, met the demands of the patients and his family, but also secured their religious belief. City International Hospital has used full array of resources, medical facilities and our technical expertise to save Nguyen. G.B."
Pediatric patient Nguyen.G.B’s Liver tumor removed (10 cm in diameter)
There are very rare cases of Pediatric hepatic tumors removal surgery without accepting blood transfusion in Vietnam. If the City International Hospital hadn’t admitted saving the baby, the tumor will grow quickly and break resulting in death. Liver tumors grow very fast, without intervention; the baby's survival time is only predicted a few months. On average of 100 children with liver tumors, 30% will live for another 3-5 years. Postoperative patients should periodically make doctor visits for timely treatment and intervention.
Before being admitted at City International hospital, the patient was taken to many other major hospitals seeking for life-saving treatments but the boy was sent home every single time due to not having the solution for no blood transfusion.
Powerful doctor team at City International Hospital
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