Hemodiluição normovolêmica aguda como alternativa à transfusão sanguínea em cirurgias eletivas / Acute normovolemic hemodilution as an alternative to blood transfusion in elective surgeries

Abstract Objective: In this prospective, randomized, controlled trial we sought to evaluate the effectiveness of acute normovolemic hemodilution (ANH) in terms of decreasing the need for allogeneic transfusion after conventional unilateral total knee arthroplasty (TKA). Summary of Background Data: TKA is often performed with an occlusive tourniquet, and thus, it could be considered ideally suited for ANH, because the chief benefit of ANH is red blood cell loss reduction and the shedding of whole blood perioperatively at lower hematocrit levels. Methods: Between January 2012 and May 2012, 40 consecutive patients scheduled to undergo elective, primary, cemented, unilateral TKA for knee osteoarthritis were enrolled. Patients were randomized to either a study (ANH) group (n=20) (Group A) or a control group (n=20) (Group B). Unit of allogeneic blood transfused was considered the primary outcomes. Results : In the ANH group, less allogeneic blood transfusion (6 units in Group A vs 15 units in Group B) was required after operation. Six patients, who required a transfusion in Group A received 1 unit of allogeneic blood. In contrast, 6 of 9 patients, who required transfusion in Group B, received at least 2 units of allogeneic blood (p<0.05). There was no complication related to the methods of the protocol. Conclusions: ANH is likely to reduce postoperative allogeneic transfusion requirement in patients undergoing unilateral TKA. However, adjunctive strategies are required to further reduce allogeneic blood transfusion requirements.

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Absence of Beneficial Effect of Acute Normovolemic Hemodilution Combined with Aprotinin on Allogeneic Blood Transfusion Requirements in Cardiac Surgery

Anesthesiology ◽

10.1097/00000542-200202000-00009 ◽

2002 ◽

Vol 96 (2) ◽

pp. 276-282 ◽

Cited By ~ 30

Author(s):

Laurent Höhn ◽

Alexandre Schweizer ◽

Marc Licker ◽

Denis R. Morel

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

High Risk ◽

Blood Transfusion ◽

Allogeneic Blood ◽

Surgical Patients ◽

Control Group ◽

Acute Normovolemic Hemodilution ◽

Normovolemic Hemodilution ◽

Normal Cardiac Function

Background The efficacy of acute normovolemic hemodilution (ANH) in decreasing allogeneic blood requirements remains controversial during cardiac surgery. Methods In a prospective, randomized study, 80 adult cardiac surgical patients with normal cardiac function and no high risk of ischemic complications were subjected either to ANH, from a mean hematocrit of 43% to 28%, or to a control group. Aprotinin and intraoperative blood cell salvage were used in both groups. Blood (autologous or allogeneic) was transfused when the hematocrit was less than 17% during cardiopulmonary bypass, less than 25% after cardiopulmonary bypass, or whenever clinically indicated. Results The amount of whole blood collected during ANH ranged from 10 to 40% of the patients' estimated blood volume. Intraoperative and postoperative blood losses were not different between control and ANH patients (total blood loss, control: 1,411 +/- 570 ml, n = 41; ANH: 1,326 +/- 509 ml, n = 36). Allogeneic blood was given in 29% of control patients (median, 2; range, 1-3 units of packed erythrocytes) and in 33% of ANH patients (median, 2; range, 1-5 units of packed erythrocytes; P = 0.219). Preoperative and postoperative platelet count, prothrombin time, and partial thromboplastin time were similar between groups. Perioperative morbidity and mortality were not different in both groups, and similar hematocrit values were observed at hospital discharge (33.7 +/- 3.9% in the control group and 32.6 +/- 3.7% in the ANH group; nonsignificant) Conclusions Hemodilution is not an effective means to lower the risk of allogeneic blood transfusion in elective cardiac surgical patients with normal cardiac function and in the absence of high risk for coronary ischemia, provided standard intraoperative cell saving and high-dose aprotinin are used.

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