Utility of acute normovolemic hemodilution in major surgeries in rural area: A prospective comparative study from North India

Abstract

Introduction:Easy availability of autologous blood is difficult in rural areas. Acute normovolemic hemodilution (ANH) has been found to be an effective alternative in major surgeries where we are expecting major blood loss.Patients and Methods:A prospective comparative study was designed to evaluate the utility of ANH patients (patients receiving autologous blood) during major operations done at MRA Medical College Ambedkar Nagar, Uttar Pradesh, India. during from September 2015 to September 2016. A total of 60 patients undergoing major surgeries were randomly assigned into two groups of thirty patients’ each. Group I received homologous blood intraoperative only when required. In Group II ANH was initiated to a target hematocrit of 30% after induction of anesthesia. Various parameters such as demographic, biochemical, and hemodynamic were compared.Results:The mean value of blood withdrawn in ANH group was 650.5 ± 228 ml and it was replaced with an equal volume of 6% hydroethyl starch. There was no statistically significant variation in mean hemocrits levels in both the groups at various stages of the study. Hematocrits decreased significantly in both the groups at various stages as compared to preoperative values. The heart rate and mean blood pressure were almost similar and without statistically significant differences in both groups. Surgical blood loss in Group I was 895.29 ± 568.30 ml as compared to 765 ± 506 ml in Group II. The difference was statistically insignificant (P ≥ 0.05). The mean volume of homologous blood transfused in Group I was 850.71 ± 318.29 ml, as compared to nil in Group II which was statistically significant (P < 0.05).Conclusion:It concludes that ANH up to a target hematocrit of 30% is safe and effective in reducing the need for homologous blood in various major surgeries in institutes in rural areas.

Acute normovolemic hemodilution in major orthopedic surgery

“…2 ANH is most effective in surgeries that are associated with large amount of blood loss. 3 With the increasing public awareness of transfusion transmitted infections, autologous procedures are being increasing used during elective surgeries. Although acute normovolemic hemodilution (ANH) was introduced around three decades ago, it has not emerged as a standard intervention.…”

A prospective study to evaluate the effects of acute normovolemic hemodilution on perioperative homologous transfusion requirements in patients undergoing major surgery

“…Rai Sand Watzek et al, in their study achieved ANH with HES and concluded that it was sufficient to maintain normovolaemia. 8,9 A similar procedure was followed by Mehta et al, and Shah et al, who had withdrawn 800-1200 ml blood in CPD bottles and maintained the haemodynamic stability by infusion of 2-3 units of colloid. 4,6 In this study Bleeding and clotting time estimations were done after haemodilution.…”