Profound Hemodilution

Woerkens, E. C. S. M. Van; Trouwborst, A.; Lanschot, J.J.B. van

doi:10.1213/00000539-199211000-00029

Cited by 141 publications

(7 citation statements)

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“…In an 84-year-old male Jehovah's Witness undergoing profound hemodilution, the DO 2 crit was 4.9 mlO 2 /kg/min for a VO 2 of about 2.4 mlO 2 /kg/min; the Hb value at the DO 2 crit was 3.9 g/dl [9]. This Hb value can be defined as the critical Hb value.…”

Section: The Concept Of Physiologic Transfusion Triggermentioning

confidence: 99%

Venous oxygen saturation as a physiologic transfusion trigger

Vallet¹,

Robin²,

Lebuffe³

2010

Crit Care

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Section: The Concept Of Physiologic Transfusion Triggermentioning

confidence: 99%

Venous oxygen saturation as a physiologic transfusion trigger

Vallet¹,

Robin²,

Lebuffe³

2010

Crit Care

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“…We designed this study based on the following findings. The critical hemoglobin concentration in healthy humans, where a compensatory increase in cardiac output and oxygen extraction for anemia is maximized, and a further reduction in hemoglobin concentration would decrease oxygen consumption and compromise cellular metabolism, is certainly <5 g/dL [26–28] . Doak and Hall [29] found that patients with preserved ventricular function undergoing coronary artery surgery did not have anaerobic myocardial metabolism and did not increase the incidence of myocardial ischemia with a hemoglobin concentration of 6 to 7 g/dL.…”

Section: Discussionmentioning

confidence: 99%

“…The critical hemoglobin concentration in healthy humans, where a compensatory increase in cardiac output and oxygen extraction for anemia is maximized, and a further reduction in hemoglobin concentration would decrease oxygen consumption and compromise cellular metabolism, is certainly <5 g/dL. [26][27][28] Doak and Hall [29] found that patients with preserved ventricular function undergoing coronary artery surgery did not have anaerobic myocardial metabolism and did not increase the incidence of myocardial ischemia with a hemoglobin concentration of 6 to 7 g/dL. The subgroup analyses in this study revealed that among the 791 patients (66.9% of total studied patients) who scored six at all assessments, the individualized strategy had fewer patients who received red-cell transfusion than the restrictive (19.6% vs. 62.2%, Figure 2A) and liberal strategies (19.6% vs. 88.8%, Figure 2B); however, with similar combined in-hospital complications and mortality by day 30.…”

Section: Discussionmentioning

confidence: 99%

Individualized red-cell transfusion strategy for non-cardiac surgery in adults: a randomized controlled trial

Liao

Liu

Zhang

et al. 2023

Chinese Medical Journal

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Background:Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion.Methods:Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test).Results:We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42–39.42%; odds ratio, 3.78%; 97.5% CI: 2.70–5.30%; P<0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91–65.57%; odds ratio, 20.06; 97.5% CI: 12.74–31.57; P<0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies.Conclusion:The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries.Trial registration:ClinicalTrials.gov, NCT01597232.

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“…The critical hemoglobin concentration (Hb crit ) is typically defined as the hemoglobin concentration at which the oxygen consumption of vital organs starts to decline, depending on the oxygen delivery during isovolemic hemodilution. 11 – 16 Further hemodilution beyond Hb crit results in tissue hypoxia; ST segment depression develops, and the serum lactate concentration increases. 6 , 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

Recovery from Extreme Hemodilution (Hemoglobin Level of 0.6 g/dL) in Cadaveric Liver Transplantation

et al. 2015

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Decompensated hepatic failure occurred in a patient with a rare blood type. The patient had extreme hemodilution due to massive bleeding during liver transplantation. A shortage of matched and universal donor blood prompted us to transfuse albumin and fresh frozen plasma for intravascular volume resuscitation. The lowest hemoglobin was 0.6 g/dL, accompanied by ST depression and a serum lactate of 100 mg/dL. The accuracy of the measured value of 0.6 g/dL was confirmed. However, the patient recovered from this critical situation after transfusion, and he was eventually discharged from the hospital without significant sequelae. Maintaining normovolemia, administering pure oxygen, ensuring appropriate anesthetic depth, and maintaining minimal inotropic support were essential for this patient’s survival during massive bleeding.

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Profound Hemodilution

Cited by 141 publications

References 0 publications

Venous oxygen saturation as a physiologic transfusion trigger

Venous oxygen saturation as a physiologic transfusion trigger

Individualized red-cell transfusion strategy for non-cardiac surgery in adults: a randomized controlled trial

Recovery from Extreme Hemodilution (Hemoglobin Level of 0.6 g/dL) in Cadaveric Liver Transplantation

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