Normovolemic Hemodilution Research Articles

Platelet Function in Stored Heparinised Autologous Blood Is Not Superior to in Patient Platelet Function during Routine Cardiopulmonary Bypass

BackgroundIn cardiac surgery, cardiopulmonary bypass (CPB) and unfractionated heparin have negative effects on blood platelet function. In acute normovolemic haemodilution autologous unfractionated heparinised blood is stored ex-vivo and retransfused at the end of the procedure to reduce (allogeneic) transfusion requirements. In this observational study we assessed whether platelet function is better preserved in ex vivo stored autologous blood compared to platelet function in the patient during CPB.Methodology/Principal FindingWe measured platelet aggregation responses pre-CPB, 5 min after the start of CPB, at the end of CPB, and after unfractionated heparin reversal, using multiple electrode aggregometry (Multiplate®) with adenosine diphosphate (ADP), thrombin receptor activating peptide (TRAP) and ristocetin activated test cells. We compared blood samples taken from the patient with samples taken from 100 ml ex-vivo stored blood, which we took to mimick blood storage during normovolemic haemodilution. Platelet function declined both in ex-vivo stored blood as well as in blood taken from the patient. At the end of CPB there were no differences in platelet aggregation responses between samples from the ex vivo stored blood and the patient.Conclusion/SignificanceEx vivo preservation of autologous blood in unfractionated heparin does not seem to be profitable to preserve platelet function.

Optimizing pancreatectomy outcomes: Follow the evidence

A PubMed search of “pancreatectomy” reveals 10,376 articles, and a fraction of these represent randomized controlled trials (n = 81) [ [1] Available at: http://www.ncbi.nlm.nih.gov/pubmed. Accessed Feb 8, 2012. Google Scholar ]. The number of randomized trials performed to date by surgeons to optimize outcomes in pancreatic resection is remarkable. Some of the recent major trials are shown in Table 1. These trials form the basis for many discussions on teaching rounds and include some of the most debatable topics in surgical Morbidity and Mortality conference, such as the routine use of intraperitoneal drains and when to remove them, preoperative biliary drainage, the use of pancreatic stents, intraoperative fluid restriction, preoperative biliary stent versus no drainage, or how to close the pancreatic stump. Table 1Recent randomized controlled trials in pancreatectomy outcomes. Variable Study, year Randomization Outcome PBD van der Gaag et al., 2010 [8] van der Gaag N.A. Rauws E.A. van Eijck C.H. et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010; 362: 129 Crossref PubMed Scopus (758) Google Scholar PBD versus surgery alone 46% complication rate from PBD procedures performed preoperativelyNo difference in operative complications Anastomotic technique Berger et al., 2009 [9] Berger A.C. Howard T.J. Kennedy E.P. et al. Does type of pancreaticojejunostomy after pancreaticoduodenectomy decrease rate of pancreatic fistula? A randomized, prospective, dual-institution trial. J Am Coll Surg. 2009; 208 (discussion 47): 738 Abstract Full Text Full Text PDF PubMed Scopus (277) Google Scholar Invagination versus duct to mucosa anastomosis for pancreaticojejunostomy Statistically significant decrease in fistula rate in invagination group Pancreatic stump closure Diener et al., 2011 [10] Diener M.K. Seiler C.M. Rossion I. et al. Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): A randomised, controlled multicentre trial. Lancet. 2011; 377: 1514 Abstract Full Text Full Text PDF PubMed Scopus (396) Google Scholar Hand sewn versus stapler after distal pancreatectomy No difference in pancreatic fistula or operative mortality Duration of intraperitoneal drainage Bassi et al., 2010 [11] Bassi C. Molinari E. Malleo G. et al. Early versus late drain removal after standard pancreatic resections: Results of a prospective randomized trial. Ann Surg. 2010; 252: 207 Crossref PubMed Scopus (353) Google Scholar Early drain removal (POD 3) versus late drain removal (POD ≥ 5) Significant reduction in pancreatic fistulae, overall complications, and hospital stay and associated costs in early drain removal group Pancreatic stent Pessaux et al., 2011 [12] Pessaux P. Sauvanet A. Mariette C. et al. External pancreatic duct stent decreases pancreatic fistula rate after pancreaticoduodenectomy: Prospective multicenter randomized trial. Ann Surg. 2011; 253: 879 Crossref PubMed Scopus (194) Google Scholar External pancreatic stent versus no stent Significant decrease in pancreatic fistulae, wound infections, and delayed gastric emptying in stented group Intraoperative fluid management Fischer et al., 2010 [13] Fischer M. Matsuo K. Gonen M. et al. Relationship between intraoperative fluid administration and perioperative outcome after pancreaticoduodenectomy: Results of a prospective randomized trial of acute normovolemic hemodilution compared with standard intraoperative management. Ann Surg. 2010; 252: 952 Crossref PubMed Scopus (87) Google Scholar Acute normovolemic hemodilution versus standard fluid management No difference in transfusions between groupsHemodilution group had a significant increase in pancreatic anastomotic complications likely because of increased fluid administration PBD = Preoperative biliary drainage; POD = Post-operative day. Open table in a new tab PBD = Preoperative biliary drainage; POD = Post-operative day. Perioperative Surgical Care Bundle Reduces Pancreaticoduodenectomy Wound InfectionsJournal of Surgical ResearchVol. 174Issue 2PreviewPancreaticoduodenectomy (PD) is a complex surgical procedure with a historically high morbidity rate. The goal of this study was to determine if the implementation of a 12-measure perioperative surgical care bundle (SCB) was successful in reducing infectious and other complications in patients undergoing PD compared with a routine preoperative preparation group (RPP). Full-Text PDF

Effect of acute normovolemic hemodilution on apoptosis in hippocampal cells induced by global cerebral ischemia-reperfusion in rats

Objective To investigate the effect of acute normovolemic hemodilution (ANH) on the apoptosis in hippocampal cells induced by global cerebral ischemia-reperfusion (I/R) in rats.Methods Thirty-six healthy 50-60 day old male SD rats weighing 280-320 g were randomly divided into 3 groups ( n =12 each):group sham operation (group S); group global cerebral I/R (group I/R) and group ANH.Global cerebral I/R was produced by 4-vessel technique described by Pulsinelli et al.in groups I/R and ANH.ANH was carried out at 24 h after cauterization of bilateral vertebral arteries,before occlusion of bilateral carotid arteries.Blood was withdrawn from femoral artery until Hct was reduced to 30％ and equal volume of hydroxyethyl starch 130/0.4 sodium chloride was infused into femoral vein simultaneously.Bilateral carotid arteries were blocked for 5 min at 10 min after ANH.The rats were sacrificed at 24 h of reperfusion and their hippocampi were isolated.Apoptosis was detected by flow cytometry.The expression of Apaf-1 mRNA and caspase-3 mRNA was determined by RT-PCR.Results Global cerebral I/R significantly increased apoptosis index and up-regulated Apaf-1 mRNA and caspase-3 mRNA expression in group I/R as compared with group S.ANH significantly attenuated apoptosis and down-regulated Apaf-1 mRNA and caspase-3 mRNA expression in group ANH compared with group I/R.Conclusion ANH can reduce hippocampal cell apoptosis induced by cerebral I/R through down-regulation of Apaf-1 and caspase-3 expression in hippocampus. Key words: Hemodilution; Reperfusion injury; Brain; Apoptosis; Hippocampus

The intravascular volume effect of Ringer's lactate is below 20%: a prospective study in humans

IntroductionIsotonic crystalloids play a central role in perioperative fluid management. Isooncotic preparations of colloids (for example, human albumin or hydroxyethyl starch) remain nearly completely intravascular when infused to compensate for acute blood losses. Recent data were interpreted to indicate a comparable intravascular volume effect for crystalloids, challenging the occasionally suggested advantage of using colloids to treat hypovolemia. General physiological knowledge and clinical experience, however, suggest otherwise.MethodsIn a prospective study, double-tracer blood volume measurements were performed before and after intended normovolemic hemodilution in ten female adults, simultaneously substituting the three-fold amount of withdrawn blood with Ringer's lactate. Any originated deficits were substituted with half the volume of 20% human albumin, followed by a further assessment of blood volume. To assess significance between the measurements, repeated measures analysis of variance (ANOVA) according to Fisher were performed. If significant results were shown, paired t tests (according to Student) for the singular measurements were taken. P < 0.05 was considered to be significant.ResultsA total of 1,097 ± 285 ml of whole blood were withdrawn (641 ± 155 ml/m2 body surface area) and simultaneously replaced by 3,430 ± 806 ml of Ringer's lactate. All patients showed a significant decrease in blood volume after hemodilution (-459 ± 185 ml; P < 0.05) that did not involve relevant hemodynamical changes, and a significant increase in interstitial water content (+2,157 ± 606 ml; P < 0.05). The volume effect of Ringer's lactate was 17 ± 10%. The infusion of 245 ± 64 ml of 20% human albumin in this situation restored blood volume back to baseline values, the volume effect being 184 ± 63%.ConclusionsSubstitution of isolated intravascular deficits in cardiopulmonary healthy adults with the three-fold amount of Ringer's lactate impedes maintenance of intravascular normovolemia. The main side effect was an impressive interstitial fluid accumulation, which was partly restored by the intravenous infusion of 20% human albumin. We recommend to substitute the five-fold amount of crystalloids or to use an isooncotic preparation in the face of acute bleeding in patients where edema prevention might be advantageous.

Heart retransplantation in children without the use of blood product

This article reports a case of a cardiac retransplantation without the use of blood products, in a 6 year old, with severe dilated cardiomyopathy after chronic graft rejection and refractory to clinical treatment. To avoid a blood transfusion in this surgery a multidisciplinary approach was planned, which involved the use of preoperative erythropoietin, acute normovolemic hemodilution and intraoperative cell savage with autologous blood recovery system, as well as a meticulous hemostasis and reduced postoperative phlebotomy.

Cerebral Effect of Acute Normovolemic Hemodilution During Brain Tumor Resection

Acute normovolemic hemodilution (ANH) is used in major surgery expected to be accompanied by excessive blood loss. Reducing the hemoglobin content may disturb cerebral oxygen balance. The aim of this study was to assess the effect of ANH on cerebral oxygen balance in patients subjected to brain tumor resection. Forty patients were randomly allocated into 2 groups (hemodilution and control). In the hemodilution group (HG), 1000 mL of blood was drawn and replaced with the same volume of HES 130/0.4 (6%, Voluven) colloid. In the control group (CG), no blood was drawn, and hemodynamics were stabilized using normal saline until allogenic blood was needed. Arterial and jugular bulb blood samples obtained after induction (basal, sample 1), 40 minutes after induction (or on completion of hemodilution, sample 2), after surgical hemostasis (sample 3), and just before extubation (sample 4) were used for the calculation of arterial-jugular oxygen content difference "Ca-jO(2)," cerebral oxygen extraction "CEO(2)," estimated cerebral metabolic rate for oxygen "eCMRO(2)," cerebral blood flow equivalent "CBFe," and jugular-arterial lactate difference "J-ALD" in both groups. Jugular oxygen saturation "SjvO(2)", CEO(2), and J-ALD showed no significant difference when the 2 groups were compared at the corresponding time points and when the values obtained at different time points were compared with the basal value in the same group. In CG, "Ca-jO(2)" significantly decreased at the end of surgery and before tracheal extubation (P<0.003 and 0.002, respectively). In HG, it decreased after hemodilution, with P value of less than 0.032. eCMRO(2) was significantly reduced in CG 40 minutes after induction of anesthesia, at the end of surgery, and before tracheal extubation (P<0.021, 0.001, and 0.001, respectively). In HG, eCMRO(2) was significantly reduced at the end of hemodilution and at the end of surgery with P value of less than 0.005 and 0.034, respectively. CBFe was significantly increased in CG at the end of surgery and before tracheal extubation (P<0.005 and 0.022, respectively). It was also increased after hemodilution in HG (P<0.042). There were no significant differences in Ca-jvO(2), eCMRO(2), and CBFe between the 2 groups. ANH and allogenic blood transfusion used in this study design were accompanied by comparable cerebral oxygenation parameters in patients subjected to brain tumor resection.

Non-blood medical care in gynecologic oncology: a review and update of blood conservation management schemes

This review attempts to outline the alternative measures and interventions used in bloodless surgery in the field of gynecologic oncology and demonstrate their effectiveness. Nowadays, as increasingly more patients are expressing their fears concerning the potential risks accompanying allogenic transfusion of blood products, putting the theory of bloodless surgery into practice seems to gaining greater acceptance. An increasing number of institutions appear to be successfully adopting approaches that minimize blood usage for all patients treated for gynecologic malignancies. Preoperative, intraoperative and postoperative measures are required, such as optimization of red blood cell mass, adequate preoperative plan and invasive hemostatic procedures, assisting anesthetic techniques, individualization of anemia tolerance, autologous blood donation, normovolemic hemodilution, intraoperative cell salvage and pharmacologic agents for controlling blood loss. An individualised management plan of experienced personnel adopting a multidisciplinary team approach should be available to establish non-blood management strategies, and not only on demand of the patient, in the field of gynecologic oncology with the use of drugs, devices and surgical-medical techniques.

Autologous blood in obstetrics: where are we going now?

In developed countries1, pregnancy-related transfusion accounts for about 6 percent of red blood cell (RBC) units transfused. This means that, for example, in the UK as a whole, approximately 70,000 units of RBC are transfused to obstetric patients each year2. The pattern of blood usage is very different in countries in which diagnostic and treatment options are more limited, with 37 percent of transfusions being given to women with obstetric emergencies1. Obstetric haemorrhage is a leading cause of maternal and perinatal mortality3. Placental abruption and placenta praevia/accreta can present as antepartum haemorrhage and are risk factors for post-partum haemorrhage (PPH). Uterine atony, inversion, retained products of conception and genital tract trauma all cause PPH and account for the majority of cases of major haemorrhage. Uterine rupture is an infrequent cause of haemorrhage and maternal death and can occur spontaneously or at the site of previous uterine surgery (caesarean section or retained placenta)3. During the triennium 2006–2008, the rate of deaths from hemorrhage in the UK was 0.39 per 100,000 maternities4. The incidence of severe bleeding in childbirth has been estimated in various surveys and is approximately one in 200 to 250 deliveries4. In developed countries treatment is generally effective with an approximate case fatality rate between 1 in 600 to 800 cases of obstetric bleeding5–7. Various blood conservation techniques can reduce exposure to allogeneic blood. These include pre-operative autologous blood donation (PABD), acute normovolaemic haemodilution (ANH) and intra-operative blood salvage (IBS). PABD may cause anaemia, does not eliminate transfusion risk, cannot be used in an emergency, is not acceptable to Jehovah’s Witnesses and should be reserved for exceptional circumstances8,9. ANH may induce anaemia and cardiac failure, cannot be used in an emergency and may have a limited role in combination with other techniques9. The use of IBS has increased substantially during the last two decades and the re-infusion of shed washed blood is commonplace in many types of surgical operations in which heavy blood loss is anticipated10,11. In this technique, blood shed at the time of surgery is collected and washed, and RBC are returned to the patient as an ongoing process (Figure 1)12,13. In skilled hands, blood salvage can be quickly set up and the final product returned to the patient within minutes of collection. In addition, this technique is also acceptable to some Jehovah’s Witnesses, provided the equipment is set up in continuity with the circulation (Figure 1)14, but consent needs to be obtained on an individual basis. Figure 1 Schematic representation of a blood salvage system with a double suction setup to reduce the possible contamination of the blood suctioned from the surgical field138. In this setup, one suction line is connected to the collection reservoir and used for ... However, the safety of IBS in obstetrics has been questioned and its introduction in this clinical arena has been delayed because of theoretical concerns stemming from the historical and ongoing dispute focused on the risk of maternal-foetal anti-Rh(D) alloimmunisation and the risk of contamination of the cell-saved blood with traces of amniotic fluid (AF)15,16. The objective of this article is to review the role of autologous blood conservation techniques in obstetrics focusing on the currently available evidence regarding IBS. An overview of current European regulatory requirements on IBS will also be provided.

Acute normovolemic hemodilution

Acute normovolemic hemodilution (AHN) is a well known but poorly used “blood saving” method. The authors, based on their own experience and on the “low hematocrit” physiology, present some concepts on AHN and a clinical experience to demonstrate the usefulness and affordability of this method. Consequently we offer several tools concerning both the realization of AHN and the safe use of such dilution, suggesting simple and exciting methods to determine if, when and how to apply this blood saving system.

An Increase in Endogenous Erythropoietin Concentrations Has No Cardioprotective Effects in Patients Undergoing Coronary Artery Bypass Graft Surgery

Preliminary data showed an increase in endogenous erythropoietin (EPO) concentrations after acute normovolemic hemodilution (ANH) in patients undergoing coronary artery bypass graft (CABG) surgery. Numerous studies have shown the organ protective properties of EPO. The aim of this study was to investigate the cardioprotective effects of these increased EPO concentrations that resulted from ANH during cardiac surgery. A prospective, randomized, blind study. A university hospital. A total of 93 patients undergoing isolated CABG surgery with or without cardiopulmonary bypass (CPB). Subjects with CPB were randomized into the control (C) or ANH group. Those in the off-pump coronary artery bypass group underwent no treatment. In the ANH group, a precalculated amount of blood was withdrawn and replaced by colloids after the induction of anesthesia. Hemodynamic parameters were recorded intra- and postoperatively. Troponin concentrations were measured as a routine parameter postoperatively. Upon intensive care unit arrival, the EPO levels were higher in the ANH group than in the C group. There was no significant difference between the troponin values of the C and the ANH groups at 4 hours postoperatively. In patients undergoing CABG surgery on CPB, an increase in endogenous EPO concentrations in the physiologic range has no cardioprotective effects.

Acute normovolemic hemodilution in spinal fusion surgery

BackgroundSpinal fusion surgeries are accompanied by significant blood loss. Acute normovolemic hemodilution is one of the autologous blood transfusion techniques that is proved to improve tissue perfusion through decreasing blood viscosity. However, its effect on hemodynamics, hematologic state, and coagulation profile is controversial.Aim of the workTo detect safety of ANH as an alternative to allogenic blood transfusion in major surgeries.Patients and methodsForty adult patients undergoing spinal fusion surgery were randomly assigned into two groups: hemodilution group (group H: n = 20) and control group (group C: n = 20). Samples were collected five times. T1: just after the induction of anesthesia and before hemodilution starts. T2: just after the end of hemodilution or 40 min after the induction of anesthesia in the control group. T3: at the start of surgical closure. T4: before the reversal from residual neuromuscular effect. T5: 3 h postoperative. Samples included: Arterial blood gases (ABGs), Hb level, Ht%, serum Na+ and K+ levels, platelet count (Plt), bleeding time (BT), activated partial thromboplastin time (aPTT), and international neutralizing ratio (INR).ResultsHeart rate, arterial blood pressure and CVP showed no significant differences during intra- and postoperative times between the two groups. Reduction in Hb and Ht % occurred in both groups compared to basal and was more significantly reduced in group H compared to group C at T2. Platelets were reduced in both groups compared to basal and significantly reduced in group H at T2 compared to group C. BT, aPTT, and INR were not affected all through the study time in both groups. Serum Na+, Serum K+, and ABGs showed insignificant differences all through the study time.ConclusionsAcute normovolemic hemodilution can be considered as a safe and effective alternative for allogenic blood transfusion (avoiding all its hazards) in spinal fusion surgery.

Blood conservation strategies for emergency open cardiac surgery in a patient with anti-M.

Blood conservation strategies for emergency open cardiac surgery in a patient with anti-M.

Effects of hemodilution after traumatic brain injury in juvenile rats

Normovolemic hemodilution (HD) in adult animal studies has shown exacerbation of traumatic brain injury (TBI) lesion volumes. Similar studies in juvenile rats have not been reported and outcomes are likely to be different. This study investigated the effects of normovolemic hemodilution (21% hematocrit) in a juvenile TBI (jTBI) model. Twenty 17-day-old rats underwent moderate cortical contusion impact injury (CCI) and were divided into four groups: CCI/hemodilution (HD) (group HD), CCI/no HD (group C), Sham/HD (group SHD), and Sham/no HD (group S). Regional laser Doppler flowmetry (LDF), edema formation (MRI-T2WI), water mobility assessed using diffusion weighted imaging (MRI-DWI), open field activity tests, and histological analyses were evaluated for lesion characteristics. Hemodilution significantly increased blood flow in the HD compared to the C group after TBI. T2WI revealed a significantly increased extravascular blood volume in HD at 1, 7, and 14 days post-CCI. Edematous tissue and total contusional lesion volume were higher in HD-treated animals at 1 and 14 days. DWI revealed that HD, SHD, and C groups had elevated water mobility compared to S groups in the ipsilateral cortex and striatum. Histology showed a larger cortical lesion in the C than HD group. Open field activity was increased in HD, C, and SHD groups compared to the S group. Hemodilution results in significant brain hyperemia with increased edema formation, extravascular blood volume, and water mobility after jTBI. Hemodilution results in less cortical damage but did not alter behavior. Hemodilution is likely not to be clinically beneficial following jTBI.

Reducing Perioperative Blood Loss and Allogeneic Blood Transfusion in Patients Undergoing Major Spine Surgery

At present, individual techniques, including intraoperative acute normovolemic hemodilution, use of tranexamic acid, use of intrathecal morphine, proper positioning, and modification of operative techniques, seem most promising for reducing perioperative blood loss and allogeneic blood transfusion in patients undergoing major spine surgery. Other techniques including preoperative autologous predonation; mandatory discontinuation of use of antiplatelet agents; intraoperative and postoperative red-blood-cell salvage; use of aprotinin, epsilon-aminocaproic acid, recombinant factor VIIa, or desmopressin; induced hypotension; avoidance of hypothermia; and minimally invasive operative techniques require additional studies to either establish their effectiveness or address safety considerations.

Hypertonic Saline Hydroxyethylstarch Restores Right Ventricular-Arterial Coupling after Normovolemic Hemodilution in Piglets

Normovolemic hemodilution is known to inhibit hypoxic pulmonary vasoconstriction. How the coupling between the pulmonary arterial (PA) circulation and the right ventricle (RV) is affected by normovolemic hemodilution and by the composition of replacement solutions remains unknown. Therefore, the effects of isotonic and hypertonic saline hydroxyethylstarch solutions on the pulmonary circulation and RV, in control and hypoxic conditions, were compared. Anesthetized piglets (n = 14) were equipped with manometer-tipped catheters in the RV and main PA and an ultrasonic flow probe around the main PA. The pulmonary circulation was assessed by pressure-flow relations and vascular impedance, RV afterload by effective arterial elastance (Ea), RV contractility by end-systolic elastance (Ees), and RV-PA coupling by the Ees/Ea ratio. Measurements were done in control (Fio2 0.40) and hypoxic (Fio2 0.12) conditions before and after acute normovolemic hemodilution with either 20 ml/kg isotonic saline hydroxyethylstarch (hydroxyethylstarch 130/0.4 6% in NaCl 0.9%, Voluven, Fresenius-Kabi, Sevres, France) or 5 ml/kg hypertonic saline hydroxyethylstarch (hydroxyethylstarch 200/0.5 6% in NaCl 7.2%, HyperHES, Fresenius-Kabi) solutions. Hypoxic pulmonary vasoconstriction was associated with proportional increases in Ea and Ees and did not affect RV-PA coupling. Hemodilution attenuated the hypoxic response. Hemodilution with isotonic saline hydroxyethylstarch did not affect the RV-PA coupling, whereas hemodilution with hypertonic saline hydroxyethylstarch increased Ees and the Ees/Ea ratio. In experimental normovolemic hemodilution, both in control and in hypoxic conditions, RV-PA coupling is unaffected by isotonic saline hydroxyethylstarch but improved by hypertonic saline hydroxyethylstarch, mainly because of an increase in RV contractility.

Acute normovolemic hemodilution during CABG induces diastolic dysfunction: A perioperative transesophageal echocardiography study

Acute normovolemic hemodilution during CABG induces diastolic dysfunction: A perioperative transesophageal echocardiography study

Impact of Acute Normovolemic Hemodilution with Autoplasma Transfusion on Hemostatic Parameters during Abdominal Delivery

Objective: to evaluate the impact of acute normovolemic hemodilution (ANH) with autoplasma transfusion on hemostatic parameters during cesarean section. Subjects and methods. The study covered 119 patients in whom ANH was used during cesarean section. Group 1 included 62 women undergoing ANH with autoplasma transfusion; Group 2 (control) comprised 57 pregnant women receiving ANH only. Examination of the hemostatic system involved studies of the plasma link, thromboelastogram readings, vascular platelet hemostasis and evaluation of intravascular thrombogenesis. Results. Transfusion of stored autoplasma as a hemostatic component during ANH favored the development of moderate hypercoagulation due to a significant increase in fibrinogen concentrations by 8%, r+k shortening by 11%, and a rise in the thrombodynamic potential index by 12%. A statistically significant difference has been found in the results between the groups at a stage of surgical hemostasis, which proves the best hemostat-ic effect of ANH used with autoplasma transfusion. Conclusion. The study has demonstrated that the combined use of ANH and autoplasma transfusion contributes to the stabilization of the blood coagulation potential during cesarean section and extends the feasibilities of ANH when the volume of intraoperative blood loss is as high as 25% of the circulating blood volume. Key words: cesarean section, acute normovolemic hemodilution, autoplasma transfusion, coagulation potential.

Strategies for reducing transfusions in major orthopaedic surgery.

Strategies for reducing transfusions in major orthopaedic surgery.

Management of Intraoperative Fluid Balance and Blood Conservation Techniques in Adult Cardiac Surgery

Blood transfusions are associated with adverse physiologic effects and increased cost, and therefore reduction of blood product use during surgery is a desirable goal for all patients. Cardiac surgery is a major consumer of donor blood products, especially when cardiopulmonary bypass (CPB) is used, because hematocrit drops precipitously during CPB due to blood loss and blood cell dilution. Advanced age, low preoperative red blood cell volume (preoperative anemia or small body size), preoperative antiplatelet or antithrombotic drugs, complex or re-operative procedures or emergency operations, and patient comorbidities were identified as important transfusion risk indicators in a report recently published by the Society of Cardiovascular Anesthesiologists. This report also identified several pre- and intraoperative interventions that may help reduce blood transfusions, including off-pump procedures, preoperative autologous blood donation, normovolemic hemodilution, and routine cell saver use.A multimodal approach to blood conservation, with high-risk patients receiving all available interventions, may help preserve vital organ perfusion and reduce blood product utilization. In addition, because positive intravenous fluid balance is a significant factor affecting hemodilution during cardiac surgery, especially when CPB is used, strategies aimed at limiting intraoperative fluid balance positiveness may also lead to reduced blood product utilization.This review discusses currently available techniques that can be used intraoperatively in an attempt to avoid or minimize fluid balance positiveness, to preserve the patient's own red blood cells, and to decrease blood product utilization during cardiac surgery.

Intra-operative cell salvage: a fresh look at the indications and contraindications.

Numerous approaches are used to avoid transfusion of allogeneic blood. Primary methods include, but are not limited to, erythropoietin and iron supplementation, pre-operative autologous donation, acute normovolaemic haemodilution, haemoglobin-based blood substitutes and infusible oxygen-carrying fluids, and the use of cell salvage systems. While currently unavailable in North America and Europe because of an increased risk of myocardial infarction and death1,2, research continues in the areas of haemoglobin-based blood substitutes and infusible oxygen-carrying liquids. Of the accepted strategies mentioned above, cell salvage offers the medical community a safe, resource-saving, and relatively inexpensive method to avoid allogeneic red cell transfusion. Currently, incorrect information and misconceptions regarding the use of cell salvage systems frequently portray them as expensive, ineffective, and inappropriate for use in certain clinical situations. In addition to addressing these misconceptions, this article will discuss indications and contraindications for the use of such systems.