Acute hypervolaemic haemodilution to avoid blood transfusion during major surgery

Trouwborst, A.; Woerkens, E. C. S. M. Van; Tenbrinck, R.; Daele, M. Van

doi:10.1016/0140-6736(90)92973-l

Cited by 61 publications

(25 citation statements)

References 9 publications

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“…1 verify that this entire volume remained in the vascular compartment, because the observed dilution closely matched the dilution predicted by a closed-system, one-compartment model. Prior studies in humans and animals that electively used hypervolemia to protect circulatory volume during presurgical hemodilution found no indication that it was deleterious (33,53,59,65).…”

Section: Resultsmentioning

confidence: 99%

Subcutaneous Po₂ as an index of the physiological limits for hemodilution in the rat

Pearce¹,

Waasdorp²,

Hufnagel³

et al. 2005

Journal of Applied Physiology

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Section: Resultsmentioning

confidence: 99%

Subcutaneous Po₂ as an index of the physiological limits for hemodilution in the rat

Pearce¹,

Waasdorp²,

Hufnagel³

et al. 2005

Journal of Applied Physiology

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“…Although both hemodilution techniques may save blood transfusions, it is unclear whether they influence the total amount of blood loss during surgery [61, 68]. Because AHH will increase vena caval pressure, this technique must be avoided in liver surgery [54].…”

Section: Intraoperative Phasementioning

confidence: 99%

“…Acute hemodilution can be achieved in two ways [61]. At first by a rapid infusion of fluids without blood withdrawal, called acute hypervolemic hemodilution (AHH).…”

Section: Intraoperative Phasementioning

confidence: 99%

Bloodless (Liver) Surgery? The Anesthetist’s View

Hofland

Henny²

2007

Dig Surg

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Background/Aims: An increasing amount of literature concerning blood conservation, restrictive transfusion strategies, pharmacological manipulation of the hemostatic and fibrinolytic systems, minimal invasive surgery, local hemostatic agents and guidelines for blood transfusion, is being published each year. Is ‘bloodless (liver) surgery’ or rather minimization of perioperative blood loss and transfusion requirement necessary? Methods: To answer this question, we studied key articles and checked cross-references with the support of PubMed and the Cochrane Database of systematic reviews. Results: At present there is still a need to reduce the use of blood. Pre-donation, set of transfusion triggers, (non-)pharmacological approaches to decrease surgical blood loss, hemodilution techniques, peri- and postoperative cell salvage and postoperative re-transfusion can contribute to the success of a bloodless (liver) surgery program. Conclusion: We conclude that a multidisciplinary effort has to be made through the entire chain, from the outpatient clinic through discharge from the hospital, with the utmost exertion of all team members in which surgeons play a key role in the adaptation of a bloodless (liver) surgery program to the specific needs of patients.

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“…With respect to hypervolaemic haemodilution (HHD), comparable data in the literature are very rare. Besides one clinical study on a small number of patients comparing HHD versus ANH [16], those data mainly refer to case reports [17,18]. The very few MM on HHD versus no-HHD published differ from each other in both mathematical description of the model itself [13,19] and the degree of hypervolaemia assumed [13,20,21].…”

Section: Introductionmentioning

confidence: 99%

Cost-Minimising Analysis of Acute Normovolaemic Haemodilution and Hypervolaemic Haemodilution in Saving Red Blood Cells as Compared to Transfusion of Allogeneic Blood

Singbartl¹,

Singbartl²,

Schleinzer³

et al. 2000

Transfus Med Hemother

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Background: Analysing cost data with respect to savings of red blood cells (rbc) by acute normovolaemic haemodilution (ANH) / hypervolaemic haemodilution (HHD) versus purchasing homologous packed rbc (HPRBC). Methods: Using our previously published model for ANH/HHD we calculated saving of rbc mass for various initial (45 and 40%) and minimal (haematocrit) hct levels (27, 24, 21 and 18%). ANH was performed by isovolaemic exchange of 4 units of blood (each 500 ml) versus colloid with an intravascular volume effect of 1.0. Intra-operative loss of colloid was only due to surgical blood loss. ANH units were re-transfused in reverse order; thereby maintaining isovolaemia and minimal hct level with ongoing blood loss by additional infusion of colloid. HHD was performed by pre-operative infusion of 1,000 ml colloid; assumed intravascular volume effect is 1.0. Hypervolaemia during surgical blood loss was maintained by infusion of colloid until reaching minimal hct. Elimination of the excessive colloid from the intravascular space lead to rise in hct (from minimal to final hct). This difference between final and minimal hct results in saving of rbc mass. Cost data refer to both hospital variable/acquisition cost and data given in DKG-NT (variable/acquisition cost (‘Sachkosten’) and total cost (‘Gesamtkosten’)). Results: ANH at best allows for rbc mass savings of approximately 2 units (each 190 ml of rbc). Under less ideal conditions (initial hct ≤ 40%, minimal hct ≥ 21%), rbc savings amount to approximately 1 unit. With HHD, the corresponding rbc mass saved amounts up to 1 unit at best. Our cost-minimising analysis (CMA) shows that these rbc savings by ANH/HHD are less expensive than purchasing equal amounts of allogeneic rbc mass. With respect to the underlying cost base, these 2 units are between 25% (total cost according to DKG-NT: ANH EUR 166.5 versus HPRBC EUR 221.1) and 60% (hospital variable cost: ANH EUR 61.7 versus HPRBC EUR 157.2) cheaper than corresponding units of HPRBC. rbc mass saved by HHD is even less expensive (total cost according to DKG-NT: HHD EUR 63.8 versus HPRBC EUR 135.1; hospital variable cost EUR 32.1 versus HPRBC EUR 95.2). Thus, they are approximately 53% (total cost according to DKG-NT) to 62% (hospital variable cost) less expensive than HPRBC. Conclusions: Both ANH and HHD – under ideal conditions and within their limited extent – are more cost-effective in saving rbc than transfusion of allogeneic blood. However, both the efficacy of these measures and the resulting financial savings are limited at best to 2 units of rbc for ANH and 1 unit for HHD.

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Acute hypervolaemic haemodilution to avoid blood transfusion during major surgery

Cited by 61 publications

References 9 publications

Subcutaneous Po₂ as an index of the physiological limits for hemodilution in the rat

Subcutaneous Po₂ as an index of the physiological limits for hemodilution in the rat

Bloodless (Liver) Surgery? The Anesthetist’s View

Cost-Minimising Analysis of Acute Normovolaemic Haemodilution and Hypervolaemic Haemodilution in Saving Red Blood Cells as Compared to Transfusion of Allogeneic Blood

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Acute hypervolaemic haemodilution to avoid blood transfusion during major surgery

Cited by 61 publications

References 9 publications

Subcutaneous Po2 as an index of the physiological limits for hemodilution in the rat

Subcutaneous Po2 as an index of the physiological limits for hemodilution in the rat

Bloodless (Liver) Surgery? The Anesthetist’s View

Cost-Minimising Analysis of Acute Normovolaemic Haemodilution and Hypervolaemic Haemodilution in Saving Red Blood Cells as Compared to Transfusion of Allogeneic Blood

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Subcutaneous Po₂ as an index of the physiological limits for hemodilution in the rat

Subcutaneous Po₂ as an index of the physiological limits for hemodilution in the rat