Controversies in transfusion medicine. Perioperative hemodilution: pro

Abstract

Hemodilution can obviate the need for allogeneic transfusion in some patients. However, it is only one component of a comprehensive blood conservation program and should be combined with other techniques whenever possible. While most often employed in teenagers and healthy young adults, ANH has been used in small children, the elderly, and patients of all ages who are undergoing cardiac surgery. Extreme caution should be exercised if ANH is used in patients with coronary artery disease or aortic stenosis who are undergoing noncardiac surgery, because their normal compensatory mechanisms are impaired. What usually is a safe and relatively simple procedure can become a disaster if employed in inappropriately selected patients. Careful hemodynamic monitoring and maintenance of normovolemia are critical.

Blood loss in patients for total knee arthroplasty

“…The present study was performed to clarify the necessity and to establish guidelines for preoperative blood deposition prior to TKA. There are four different types of autogenous blood deposition procedures: preoperative deposition of autogenous blood [6,19,21], isovolemic hemodilution [18], intraoperative collection of blood with cell savers [4,14,16], and postoperative collection of blood in closed system with continuous suction [2,3,5,22]. As most of the blood loss in patients with TKA derives from wound drainage in the postoperative phase, collection of the drainage blood after surgery may be the optimal method for reusing of the blood.…”

Influence of crystalloid and colloid replacement solutions on hemodynamic variables during acute normovolemic hemodilution

“…2 This technique effectively reduces the need for allogeneic blood transfusion, and the accompanying risk of transfusion-related infection and transfusion reactions. 4 There is also evidence that the transfusion of allogeneic blood may induce immunosuppression, which may be detrimental in patients undergoing surgery for malignancies. 5 ANH is less expensive than preoperative autologous donation, 1,3 and eliminates the risk of administrative error that may occur whenever banked blood is utilized.…”

Blood salvage after total hip and total knee arthroplasty

“…Preoperative deposition of autologous blood can be used to collect 3 to 5 units or, in some cases, even up to 10 units for later use (Thomson et al 1987, Woolson et al 1987, Flecknoe et al 1995. Another method for decreasing the need for homologous blood, is isovolemic hemodilution which involves the deposition of 1-2 blood units immediately before surgery with the concurrent replacement of the autologous blood along with colloids and crystal infusions in order to restore the blood volume (Stehling and Zauder 1994). Thirdly, there have reports of the successful use of intraoperative collection of blood with cell savers and retransfusion during the surgical procedure (Law and Wiedel1989, McMurray et al 1990, Elawad et al 1991.…”