Effects of standardized acute normovolemic hemodilution on intraoperative allogeneic blood transfusion in patients undergoing major maxillofacial surgery

Abstract

The aim of the present study was to demonstrate the practicality and efficacy of acute normovolemic hemodilution (ANH) to reduce allogeneic red blood cell (RBC) transfusion in patients undergoing elective surgery with anticipated high intraoperative blood loss (BL). 124 patients (age 48 +/- 18 years, ASA classes I-III) underwent major maxillofacial surgery in a university hospital (68% tumor surgery, 32% dysgnathia correction). After induction of general anesthesia, ANH was performed by standardized withdrawal of 900 ml (2 units) of whole blood and simultaneous infusion of 500 ml of hydroxyethyl starch solution (6% HES 130,000/0.4) and 1500 ml of crystalloidal solution. Intraoperative BL was fluid-compensated until physiologic parameters indicated the need for RBC transfusion. First, autologous ANH-blood was retransfused followed by, if necessary, allogeneic RBC. Total BL was referred to the patient's calculated blood volume (BV): fractional blood volume loss, BL(fract) = BL/BV. ANH took 16 +/- 2 min and was void of any adverse event. The costs for ANH was 24 per patient. 55 patients had a mean BL(fract) of 44 +/- 28% and required an intraoperative transfusion; 49/55 patients with an average BL(fract) of 37 +/- 14% were transfused with only autologous ANH-blood; 6/55 patients with a mean BL(fract) of 100 +/- 47% underwent additional transfusion with allogeneic RBC. Standardized, 2 unit, ANH is a practicable, safe and economic blood conservation technique that allowed for the complete avoidance of allogeneic RBC transfusion in 89% of patients undergoing maxillofacial surgery that required an intraoperative RBC transfusion.