Acute normovolemic hemodilution and intraoperative cell salvage in aortic surgery

Cliona Kirwan, Francesco Torella, Sarah L. Haynes, Cliona C. Kirwan, Anand N. Bhatt, Charles N. McCollum

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Objective: The objective of this study was to report current transfusion requirements and outcomes in patients undergoing elective aortic surgery with autologous transfusion. Methods: This was a retrospective review of transfusion practice in infrarenal aortic surgery in a tertiary vascular unit with a longstanding interest in autologous transfusion. One hundred and ten consecutive patients underwent infrarenal aortic surgery with a combination of acute normovolemic hemodilution (ANH) and intraoperative cell salvage (ICS). All patients underwent hemodilution to a target hemoglobin concentration of 11 g/dL and underwent ICS with a centrifugal device. Results: Median blood loss was 1140 mL (interquartile range [IQR], 683 to 1609 mL) in 78 aneurysm repairs and 775 mL (IQR, 400 to 1225 mL) in 32 aortobifemoral bypasses for occlusive disease (P = .02), resulting in a median salvaged red cell volume of 403 mL (IQR, 256 to 563 mL) for aneurysm repairs and 250 mL (IQR, 200 to 290 mL) in bypass surgery (P = .001). Thirty-six patients (33%) needed transfusion of stored blood, for a total of 115 units, with just four patients needing more than five units. The mortality rate was 8% (9/110). With multivariate analysis, low hemoglobin level (P = .006) and low platelet count (P = .023) were associated with stored blood transfusion. Conclusion: Blood loss is too small to justify ICS in surgery for occlusive disease; ANH alone may be a suitable strategy. With appropriate experience, the combination of ANH and ICS may render crossmatching unnecessary, even in aortic aneurysm surgery. Copyright © 2002 by The Society for Vascular Surgery and The American Association for Vascular Surgery.
    Original languageEnglish
    Pages (from-to)31-34
    Number of pages3
    JournalJournal of vascular surgery
    Volume36
    Issue number1
    DOIs
    Publication statusPublished - Jul 2002

    Keywords

    • Aged
    • surgery: Aorta, Abdominal
    • physiopathology: Aortic Aneurysm, Abdominal
    • physiopathology: Aortic Aneurysm, Thoracic
    • Blood Loss, Surgical
    • Blood Transfusion, Autologous
    • physiology: Blood Volume
    • Comparative Study
    • Female
    • Great Britain
    • Hemodilution
    • analysis: Hemoglobins
    • Human
    • Intraoperative Care
    • Male
    • Middle Age
    • Platelet Count
    • Salvage Therapy
    • Surgical Procedures, Elective
    • Treatment Outcome

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