Preoperative Acute Normovolemic Hemodilution for Minimizing Allogeneic Blood Transfusion

Zhou, Xi‐Lang; Zhang, Chenjing; Wang, Yin; Lu, Yu; Yan, Min

doi:10.1213/ane.0000000000001010

Cited by 85 publications

(49 citation statements)

References 66 publications

(69 reference statements)

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“…Acute normovolemic hemodilution (ANH), a technique performed immediately prior to a procedure at high risk for blood loss, has been shown to reduce the need for allogenic transfusion [9]. During ANH, whole blood is removed from the patient and replaced with a crystalloid/colloid mixture to maintain euvolemia.…”

Section: Introductionmentioning

confidence: 99%

A prospective trial of acute normovolemic hemodilution in patients undergoing primary cytoreductive surgery for advanced ovarian cancer

Tanner

Filippova

Gardner

et al. 2018

Gynecologic Oncology

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Objectives: Our objective was to determine the safety and efficacy of acute normovolemic hemodilution (ANH) to reduce the requirement for allogenic red blood cell (RBC) transfusions in patients undergoing primary cytoreduction for advanced ovarian cancer. Methods: Patients undergoing primary cytoreduction for advanced ovarian cancer were enrolled in a prospective trial assessing ANH at time of surgery. Intraoperative blood withdrawal was performed to a target hemoglobin of 8.0 g/dL. A standardized transfusion protocol first using autologous then allogenic blood was applied intraoperatively and throughout hospitalization according to institutional guidelines. The primary endpoint was to determine the overall rate of allogenic RBC transfusions in the intra- and postoperative periods. A predetermined allogenic RBC transfusion rate <35% was deemed a meaningful reduction from a 50% transfusion rate in historical controls. Results: Forty-one patients consented to participate. Median blood withdrawn during ANH was 1650 mL (range, 700–3000). Cytoreductive outcomes were as follows: 0 mm, 30 (73%); 1–10 mm, 8 (20%); and >10 mm, 3 (7%) residual disease. Estimated blood loss was 1000 mL (range, 150–2700). Fourteen patients (34%) received allogenic RBC transfusions intra- or postoperatively, meeting the primary endpoint. No patients were transfused outside protocol guidelines. The rate of ≥ grade 3 complications (20%) and anastomotic leaks (7%) were similar to historical controls and met predefined safety thresholds. Conclusions: For patients with advanced ovarian cancer undergoing primary cytoreductive surgery, ANH appears to reduce allogenic RBC transfusion rates versus historical controls without increasing perioperative complications. Further evaluation of the technique is warranted.

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Section: Introductionmentioning

confidence: 99%

A prospective trial of acute normovolemic hemodilution in patients undergoing primary cytoreductive surgery for advanced ovarian cancer

Tanner

Filippova

Gardner

et al. 2018

Gynecologic Oncology

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show abstract

“…Our results further supported previous findings that the use of ANH could reduce intraoperative RBC transfusions in patients undergoing cardiac surgery [ 6 , 7 , 21 ], even though blood loss was similar between the ANH and non-ANH groups in our study. Some meta-analysis also supported that ANH is effective in minimizing blood transfusion in patients undergoing cardiac surgery [ 15 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…There is also an increasing concern about the improved outcomes associated with ANH [ 7 , 13 , 14 ]; the safety of ANH still remains uncertain [ 15 ]. We performed this study to assess the relationship between mild volume ANH, perioperative transfusions, and outcomes in Chinese patients undergoing cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Mild volume acute normovolemic hemodilution is associated with lower intraoperative transfusion and postoperative pulmonary infection in patients undergoing cardiac surgery -- a retrospective, propensity matching study

et al. 2017

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BackgroundPerioperative allogenic transfusion is required in almost 50% of patients undergoing cardiac surgery and is associated with higher risk of mortality and morbidity (Xue et al., Lancet 387:1905, 2016; Ferraris et al., Ann Thorac Surg 91:944–82, 2011). Acute normovolemic hemodilution (ANH) is recommended as a potential strategy during cardiac surgery, but the blood conservation effect and the degree of ANH was still controversial. There is also an increasing concern about the improved outcomes associated with ANH. Therefore, a better understanding of the effect of mild volume ANH during cardiac surgery is urgently needed.MethodsThis retrospective study included 2058 patients who underwent cardiac surgery between 2010 and 2015. The study population was split into two groups (with and without mild volume ANH). Propensity score adjustment analysis was applied. We reported the association between the use of mild volume ANH and perioperative outcomes.ResultsA total of 1289 patients were identified. ANH was performed in 358 patients, and the remaining 931 patients did not receive any ANH. Five hundred of the total patients (38.8%) received perioperative RBC transfusions, 10% (129/1289) of patients received platelet, and 56.4% (727/1289) of patients received fresh frozen plasma transfusions. Mild volume ANH administration was significantly associated with decreased intraoperative RBC transfuse rate (8.5% vs. 14.4%; p = 0.013), number of RBC units (p = 0.019), and decreased postoperative pulmonary infection (6.8 vs. 11.3%; p = 0.036) during cardiac surgery. However, there was no significant difference regarding intraoperative fresh frozen plasma (FFP) and platelet concentrate transfusions, as well as postoperative and total perioperative allogeneic transfusions. Furthermore, there was no significant difference regarding postoperative outcomes including mortality, prolonged wound healing, stroke, atrial fibrillation, reoperation for postoperative bleeding and acute kidney injury. There was also no difference in postoperative ventilation time, length of ICU and hospital stay.ConclusionBased on the 5-year experience of mild volume ANH in cardiac surgeries with CPB in our large retrospective cohort, mild volume ANH was associated with decreased intraoperative RBC transfusion and postoperative pulmonary infection in Chinese patients undergoing cardiac surgery. However, there was no significant difference regarding postoperative and total perioperative allogeneic transfusions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-017-0305-7) contains supplementary material, which is available to authorized users.

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“…Some studies reported that large volume hemodilution was associated with adverse complications. [ 22 , 23 ] Finally, although the strict exclusion criteria was assumed to minimize biases, the potential bias factors, such as population characteristics, may not be completely eliminated in our study.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of acute normovolemic hemodilution in patients undergoing intracranial meningioma resection

Yang

Wei

2017

Medicine

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The aim of this study was to evaluate the safety of acute normovolemic hemodilution (ANH) for patients undergoing intracranial meningioma resection.Eighty patients (aged 48–65 years) with American Society of Anesthesiologists physical status I–II undergoing intracranial meningioma resection were included in this prospective observational study. The patients were randomly divided into group A (ANH group), which underwent a combination of ANH and intraoperative cell salvage (ICS), and group B (control group), which underwent ICS alone. The study parameters were recorded as baseline values before blood drainage (T0), after blood drainage (T1), and before (T2) and after (T3) retransfusion in group A. Whereas in group B, the same parameters were measured 10 minutes after anesthesia induction (T0), before surgery (T1), and before (T2) and after (T3) transfusion of autologous blood.When intraoperative blood loss was <2000 mL, the mean volume of homologous blood transfused in group A patients was 100.8 ± 82.3 mL, compared with the 190.0 ± 91.8 mL in group B. Reduction in homologous blood used in group A was statistically significant (P < .05). In group B, 15.1% patients received homologous blood, whereas only 5.9% patients received homologous blood in group A. The difference in heart rate between both groups at different time points was statistically nonsignificant (P > .05). The mean hemoglobin and hematocrit levels at T1 and T2 in group A were lower than in group B (P < .05). The prothrombin time and activated partial thromboplastin time in both groups were prolonged significantly after T2 (all P < .05), but were all within normal range. There were no significant differences in postoperative hospital stay, mortality, and postoperative infection between the 2 groups.For patients undergoing excision of intracranial meningioma, ANH is an effective procedure to reduce the need for allogeneic transfusions.

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Preoperative Acute Normovolemic Hemodilution for Minimizing Allogeneic Blood Transfusion

Abstract: Although these results suggest that PANH is effective in reducing allogeneic blood transfusion, we identified significant heterogeneity and publication bias, which raises concerns about the true efficacy of PANH.

Cited by 85 publications

References 66 publications

A prospective trial of acute normovolemic hemodilution in patients undergoing primary cytoreductive surgery for advanced ovarian cancer

A prospective trial of acute normovolemic hemodilution in patients undergoing primary cytoreductive surgery for advanced ovarian cancer

Mild volume acute normovolemic hemodilution is associated with lower intraoperative transfusion and postoperative pulmonary infection in patients undergoing cardiac surgery -- a retrospective, propensity matching study

Evaluation of acute normovolemic hemodilution in patients undergoing intracranial meningioma resection

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