This case report describes bloodless management of a 32-year-old Jehovah's Witness who had severe obstetric hemorrhage at 23 weeks of gestation, spontaneously delivering twin fetuses. After resuscitation with crystalloids and colloids, the patient was still bleeding and hemoglobin fell to 3.3 g/dL. She had emergency hysterectomy. On postoperative day 1, her hemoglobin was 1.3 g/dL and Glasgow Coma Scale 6 of 15. Electrolyte derangement and fluid overload were detected and treated promptly. She regained consciousness and received intravenous iron and erythropoietin. She recovered fully without complications and without blood transfusion. Hemoglobin at discharge (postoperative day 18) was 6.9 and 12.5 g/dL 4 months later.
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