Pro: Acute Normovolemic Hemodilution Should Be Used in Infective Endocarditis Patients Coming for Primary or Redo Cardiac Surgery

Abstract

ACUTE NORMOVOLEMIC HEMODILUTION (ANH) is a blood conservation strategy well-known to reduce allogeneic blood transfusion. More specifically, perioperative autologous whole blood collection and reinfusion during cardiac surgery have been shown to reduce allogeneic red blood cell (RBC) transfusions (4% v 44% in a control group). 1 Henderson RA Judd M Strauss ER et al. Hematologic evaluation of intraoperative autologous blood collection and allogeneic transfusion in cardiac surgery. Transfusion. 2021; 61: 788-798 Crossref PubMed Scopus (8) Google Scholar In addition, the use of ANH has the potential to improve coagulation parameters, thereby reducing the administration of clotting factors and other blood products. 1 Henderson RA Judd M Strauss ER et al. Hematologic evaluation of intraoperative autologous blood collection and allogeneic transfusion in cardiac surgery. Transfusion. 2021; 61: 788-798 Crossref PubMed Scopus (8) Google Scholar , 2 Barile L Fominskiy E Di Tomasso N et al. Acute normovolemic hemodilution reduces allogeneic red blood cell transfusion in cardiac surgery: A systematic review and meta-analysis of randomized trials. Anesth Analg. 2017; 124: 743-752 Crossref PubMed Scopus (93) Google Scholar , 3 Henderson RA Mazzeffi MA Strauss ER et al. Impact of intraoperative high-volume autologous blood collection on allogeneic transfusion during and after cardiac surgery: A propensity score matched analysis. Transfusion. 2019; 59: 2023-2029 PubMed Google Scholar This has been attributed to the shielding effect of ANH on platelets and clotting factors from activation, consumption, and shearing stress injury from the cardiopulmonary bypass (CPB) circuit. ANH also improves tissue perfusion by hemodilution, enhances body's tolerance to blood loss, and likely reduces surgical blood loss. 4 Zhou J. A review of the application of autologous blood transfusion. Braz J Med Biol Res. 2016; 49: e5493 Crossref PubMed Scopus (26) Google Scholar Other potential benefits of ANH are bone marrow stimulation and the endogenous regeneration of hematopoietic cells, leading to faster recovery from anemia after surgery.