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Discussion Starter · #1 ·
A postmenopausal 50-year-old woman with cryptogenic liver cirrhosis and coagulopathy was admitted to the hospital for severe vaginal bleeding secondary to uterine fibroids. The patient was deemed to be a poor surgical candidate because of her coagulopathy, and she was transferred to the medicine service for preoperative management, including packed red blood cells (PRBCs) and fresh frozen plasma transfusions. Although the patient initially agreed to receive transfusions, after 2 units of PRBCs she refused further transfusions, stating “I want a more definitive treatment than just receiving transfusions!” The patient’s hematocrit, however, was steadily decreasing and the patient continued to experience vaginal bleeding. Although the internist thoroughly explained the nature, indications, risks, benefits, and alternatives regarding blood product transfusions, the patient still refuses to receive blood products. The patient denies feeling depressed, and is alert and oriented to time, place, and person. There are no signs of depression or suicidality.

Which of the following is the most appropriate next step in patient care?
(A) Call the ethics committee and seek approval to override the patient’s decision
(B) Call for psychiatry consultation to determine competence
(C) Hold transfusions and have a discussion with the gynecology consult service regarding alternatives to surgery, such as interventional radiology procedures
(D) Since the patient had given consent for earlier transfusions, the internist should continue the transfusions and reverse the coagulopathy to prepare the patient for surgery
(E) Talk to patient’s husband and seek his consent for the patient’s transfusions
 

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Discussion Starter · #2 ·
Answer is C

The answer is C
There's noway that you ignore the patient will and you have to work around it. The case is not an Emergency so "listen to the patient" :)
 
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