Topic: C. Clinical GI
Acute Normovolemic Hemodilution Versus Standard Intraoperative Management in Patients Undergoing Major Hepatic Resection: Results of a Prospective Randomized Trial
William R Jarnagin, Mithat Gonen, Shishir K Maithel, Yuman Fong, Michael I D'Angelica, Ronald P DeMatteo, Florence Grant, David Wuest, Leslie H Blumgart, Mary Fischer
Memorial Sloan-Kettering Cancer Center, New York, NY
OBJECTIVE(S): Hepatic resection can be associated with considerable blood loss. The resulting need for blood products exposes patients to potentially serious complications and further stresses the blood supply. The aim of this study was to determine if acute normovolemic hemodilution (ANH), an established blood conservation technique, reduces the requirement for allogeneic red cell transfusions in patients undergoing major hepatic resection.
METHODS: One hundred thirty patients undergoing major hepatic resection (≥3 segments) were randomized to ANH or standard management (STD). In the ANH group, intraoperative blood collection was performed to a target hemoglobin of ~8.0g/dL. Low CVP anesthetic technique and standardized transfusion criteria were used for all patients.
RESULTS: From 5/04-3/07, 67 patients were randomized to STD and 63 to ANH. Compared to STD, ANH reduced the red cell transfusion rate by 50% (12.7% vs. 25.4%, p=0.067); additionally, ANH patients were less often transfused intra-operatively (1.6% vs. 10.4%, p=0.036), had higher postoperative hemoglobin levels (p=0.01), and tended to require fewer red cell units overall (28 vs. 47 units). In patients with operative blood loss ≥800ml (n=62), ANH reduced not only the allogeneic red cell transfusion rate (18.2% vs. 42.4%, p=0.045) but also the proportion of patients requiring fresh frozen plasma (21.1% vs. 48.3%, p=0.025). Major morbidity (≥Grade 3) was no different between the groups (30% ANH vs. 28% STD, p=0.82).
For patients undergoing major liver resection, ANH is safe, reduces the allogeneic transfusion rate, and should be considered for routine use.