Data Availability StatementNot applicable Abstract Background Anti-Gerbich (Ge) alloantibody against high-frequency erythrocyte antigen is incredibly rare. Thunderbeat? with Pringle maneuver and infra-hepatic inferior vena cava clamping without perioperative need for an allogeneic blood transfusion. She has been alive without recurrence after a follow-up period of 45 months. Conclusion To our knowledge, this is the first case report of hepatectomy in a patient with anti-Ge alloantibody. A multidisciplinary team approach, PAD and ANH, and bloodless liver surgical techniques appear to be useful for major hepatectomy in patients with extremely rare blood type. not testedpolyethylene glycol The management of the patient was intensively discussed with a multidisciplinary team of experts from the departments of hematology, clinical laboratory, oncology, hepatology, radiology, and anesthesiology. Since it was hard to predict the degree and severity of adverse Quetiapine fumarate events related to HTRs by incompatible Quetiapine fumarate transfusion, preoperative autologous donation (PAD) and acute normovolemic hemodilution (ANH) were planned to avoid perioperative allogenic blood transfusion as far as possible. After explaining the risks and benefits of the surgical intervention with the possibility of incompatible transfusion to the patient, she agreed to proceed for the surgery. A total of 800 ml Rabbit Polyclonal to DP-1 autologous blood was preserved preoperatively under erythropoietin therapy, epoetin beta 6000 IU intravenous administration three times a week, supplemented by the daily administration of iron. Warfarin was interrupted 4 days before surgery, subsequently intravenous unfractionated heparin was started at 10,000 units per day, and stopped 6 h before surgery. Several measures were incorporated after the induction of general anesthesia. These included insertion of Swan-Gantz catheter for evaluation of cardiac function for moderate to severe aortic stenosis; insertion of a flexible double lumen catheter for continuous hemodiafiltration (CHDF) in preparation to deal acute HTRs preceded by an unanticipated transfusion; a collection of 700 ml autologous blood as ANH; and a stand-by set up of intraoperative cell salvage. Surgery was performed through an inverted T-shaped incision. The tumor was located in the S4, S5, and S8 of Quetiapine fumarate the liver (Fig. ?(Fig.2a).2a). First, a cholecystectomy with an insertion of a 6 Fr. tube via a cystic duct for post-hepatectomy bile leakage test was performed, and was followed by the dissection of the hepatic hilum. The middle hepatic artery and the anterior branch of the right hepatic artery originated from the superior mesenteric artery were ligated and divided. Infra-hepatic inferior vena cava (IVC) above the confluence of the left renal vein was encircled by a cotton tape with a tourniquet (Fig. ?(Fig.2b).2b). Mobilization of the right lobe of the liver was performed with the division of the right coronary, triangle, and the hepato-renal ligaments, while the short hepatic veins were not divided. Liver transection was performed with Thunderbeat? (TB) (Olympus Medical Systems Corp., Tokyo, Japan) and a cavitron ultrasonic Quetiapine fumarate surgical aspirator (CUSA) along with the Pringle maneuver in cycles of clamp/unclamp time of 15/5 min. After intravenous administration of 100 mg of hydrocortisone, parenchymal transection was initiated to the falciform ligament simply, where inflow buildings of S4 arising from the hilar dish were divided and ligated. Through the transection of parenchyma upon this plane, right down to the para-caval portion of the caudate lobe, we encountered a longitudinal divide injury in the dorsal aspect of the center hepatic vein on the confluence of 1 from the drainage blood vessels from S4B. The liver organ was transected simply still left to the proper hepatic vein through the use of TB Quetiapine fumarate by itself under simultaneous Pringle maneuver and infra-hepatic IVC clamping, while protecting hemostasis with digital compression from the harmed portion. The center hepatic vein was clamped about 2 cm distal from its main, divided, and dual ligated on the proximal site. Glissonian pedicles of S8 and S5 was dual ligated and divided, respectively, and a CH without caudate lobectomy was performed (Fig. ?(Fig.2c).2c). Nevertheless, a small part of S8 and S4B was spared. Frozen parts of the operative margins revealed harmful margins. Hemostasis from the transection series was attained with suture ligation and gentle coagulation. Bile leakage check was performed through the use of indigocarmine dye. Tachosil? was.