Acute Normovolemic Hemodilution

Goodnough, Lawrence T.

doi:10.1111/j.1778-428x.1999.tb00003.x

Cited by 3 publications

(2 citation statements)

References 38 publications

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“…Acute normovolaemic haemodilution has been recommended as a blood conservation strategy , however, its effects on blood coagulation and platelet function remain unclear. The technique provides fresh whole blood containing red cells, coagulation factors and platelets .…”

Section: Discussionmentioning

confidence: 99%

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The effects of acute normovolaemic haemodilution on peri‐operative coagulation in total hip arthroplasty

Shin

Hwan

2014

Anaesthesia

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SummaryTotal hip arthroplasty results in substantial blood loss in the peri-operative period. We evaluated the effects of acute normovolaemic haemodilution on blood coagulation and platelet function in 11 patients undergoing total hip arthroplasty. We performed acute normovolaemic haemodilution and haematological tests, rotational thromboelastometry (ROTEM â ) and whole-blood impedance aggregometry. Blood samples were obtained at three time points: (i) before the initiation of acute normovolaemic haemodilution; (ii) 20 min after completion of acute normovolaemic haemodilution; and (iii) 20 min after retransfusion. After acute normovolaemic haemodilution, ROTEM parameters demonstrated hypocoagulability. Clot formation time of INTEM was increased by 31.6% (p = 0.016), whereas the a-angle and maximum clot formation of INTEM decreased by 8.1% (p = 0.032) and 3.0% (p = 0.013) respectively, compared with baseline values. Clotting time and clot formation time of EXTEM were increased by 40.8% (p = 0.042) and 31.3% (p = 0.016), respectively, whereas the a-angle and maximum clot formation of EXTEM were decreased by 11.9% (p = 0.020) and 9.5% (p = 0.013), respectively. The maximum clot formation of FIBTEM decreased by 35.1% compared with the baseline value (p = 0.007). Following retransfusion, ROTEM values returned to baseline; clot formation time decreased and the a-angle and maximum clot formation increased. There were no significant changes in platelet aggregation during the study. At 20 min after the end of acute normovolaemic haemodilution, the international normalised ratio of prothrombin time was increased compared with the baseline value (p = 0.003). We conclude that acute normovolaemic haemodilution resulted in a hypocoagulable state compared with baseline values and that coagulation parameters returned to normal after retransfusion.

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Section: Discussionmentioning

confidence: 99%

“…Acute normovolaemic haemodilution (ANH) is one method for blood conservation during surgery associated with a high risk of bleeding . Acute normovolaemic haemodilution is cost effective, does not require compatibility testing and avoids the risks associated with red cell storage .…”

Section: Introductionmentioning

confidence: 99%

The effects of acute normovolaemic haemodilution on peri‐operative coagulation in total hip arthroplasty

Shin

Hwan

2014

Anaesthesia

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Clinical Hemodilution

Meßmer¹,

Kemming²

2006

Blood Substitutes

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Perioperative hemodilution

Kreimeier¹,

Meßmer²

2002

Transfusion and Apheresis Science

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Acute normovolemic hemodilution (ANH) entails the removal of blood from a patient either immediately before or shortly after induction of anesthesia and the simultaneous replacement with cell-free fluid, preferably synthetic colloids with a predictable volume effect (6% dextran 60/70, 6% hydroxyethyl starch 200,000 and 130.000, respectively). Hemodilution is part of the concept for avoiding or limiting the use of allogeneic blood and should be considered for patients undergoing elective surgery free of contraindications and presenting with an initial hemoglobin concentration > or = 12 g/dl and an anticipated blood loss of > or = 1500 ml. The efficacy of ANH, judged by the necessity to transfuse homologous blood, depends on the preoperative (initial) hematocrit, the target hematocrit (to which hemodilution is performed), and the preset intra- and postoperative transfusion trigger. In the past data from clinical trials have shown that in healthy subjects a target hematocrit of 20-25% (7.0-8.0 g/dl hemoglobin concentration) is feasible and safe for the patient. The lower the target hemoglobin concentration, the more extensive monitoring is required: intraoperative target hemoglobin concentrations of 5.0 g/dl and less have been tolerated by young surgical patients without adverse effects. The safety as well as efficacy of acute normovolemic hemodilution in terms of reducing homologous blood transfusion requirements have been demonstrated in various clinical studies. ANH therefore is regarded an integral part of programs aimed at reducing the need for homologous blood, and can thus be successfully combined with preoperative autologous blood deposition, intraoperative blood salvage and carefully adjusted surgical techniques.

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Acute Normovolemic Hemodilution

Cited by 3 publications

References 38 publications

The effects of acute normovolaemic haemodilution on peri‐operative coagulation in total hip arthroplasty

The effects of acute normovolaemic haemodilution on peri‐operative coagulation in total hip arthroplasty

Clinical Hemodilution

Perioperative hemodilution

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