Effects of acute normovolemic hemodilution on allogeneic blood transfusion & coagulation in orthognathic surgery: A randomized study

Abstract

Background Acute normovolemic hemodilution (ANH) is one of the important techniques predominantly used in cardiac, hepatic, and vascular surgery for decreasing allogeneic blood transfusion. However, the effect of ANH in orthognathic surgery has been rarely studied. Therefore, this study aims to assess the ANH‐mediated reduction in the allogeneic red blood cell transfusion for orthognathic surgery patients. Study design and methods In this single‐center study, 18–80 years old patients were recruited. Patients with hemoglobin ≥11 g/dL and normal coagulation function were randomly divided into ANH or standard treatment group. Results Ninety six patients underwent ANH, and 101 patients received standard treatment. No differences in demographic or major pre‐operative characteristics were observed between the two groups. One patient in the ANH and three patients in the standard treatment group received allogeneic blood [3(2.97%) vs. 1(1.16%), control vs. ANH, p = .395]. Multivariate logistic regression analysis revealed that ANH treatment was not associated with transfusion of allogeneic blood (p = .763). After retransfusing autologous blood, PT and APTT in the ANH group significantly increased compared to standard treatment group (PT: −1.73 ± 1.09 vs. −2.15 ± 1.06, p = .035; APTT: −6.39 ± 5.76 vs. −8.16 ± 5.70, p = .031; control vs. ANH). No significant differences between the two groups were observed for changes in coagulation parameters at first postoperative day. However, platelet counts in the ANH group decreased compared to the standard group. No significant difference in major adverse outcomes was observed between the two groups. Conclusion ANH did not reduce the incidence of allogeneic transfusion in patients undergoing orthognathic surgery.

In response: Not all acute normovolemic hemodilutions are created equal

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We read with great interest the work by Li et al 1 The authors hypothesized that red blood cell (RBC) transfusions in orthognathic surgery could be reduced by acute normovolemic hemodilution (ANH); 187 patients were randomly assigned to conventional management or ANH. There is a renewed interest in ANH as part of perioperative multimodal blood conservation strategy.

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“…Li et al 1 Henderson et al 4 Type due to dilutional coagulopathy. Fibrinolysis in the oral cavity seems to contribute to increased blood loss.…”