ABSTRACT

Case history An 11-year-old girl with cerebral palsy and bilateral dislocated hips is referred for pre-operative anaesthetic assessment. The hips are increasingly painful and the surgical plan is for major pelvic reconstruction including open reduction of both hips, bilateral femoral osteotomies and bilateral acetabular osteotomies. This procedure will involve significant and possibly major haemorrhage. The child’s parents are Jehovah’s Witnesses and refuse to allow their daughter to have a blood transfusion. Preoperative assessment revealed findings documented in Table 28.1.