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Acute limited normovolemic hemodilution: A method for avoiding homologous transfusion

  • Progress Symposium-Hemotherapy
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Abstract

Preoperative normovolemic hemodilution was introduced for clinical application by Messmer and co-workers. Preoperative blood withdrawal of 1,500–2,000 ml by an isovolemic exchange with colloids or crystalloids (3 times the volume of blood withdrawn), in order to maintain a constant circulating volume, is offset by an adequate increase of cardiac output and an unchanged systemic oxygen transport capacity despite a decreased oxygen content. Patients lose fewer red cells and more plasma intraoperatively. The retransfusion of autologous blood follows in the reverse order of collection after hemostasis is restored. The procedure is a safe and feasible method, which is not beset with the logistical problems of autologous blood predeposit and has the added advantage that fresh autologous blood is available at once for retransfusion. Provided that the contraindications are observed, the technique helps to reduce or even avoids the risks of homologous blood transfusion. The need for stored blood can be reduced by 20% to 90%, depending on the surgical procedure.

Résumé

L'hémodilution normovolémique pré-opératoire a été instaurée en chirurgie par Messmer et ses collaborateurs. Le prélèvement de sang du malade immédiatement avant le début de l'acte chirurgical, lors de l'induction de l'anesthésie, de 1,500 à 2,000 ml de sang, et leur remplacement isovolémique par des colloïdes ou des cristalloïdes (3 fois le volume de sang soustrait) dans le but de maintenir un volume circulatoire constant, est compensé par une élévation adéquate du débit cardiaque et par une capacité inchangée du transport de l'oxygène en dépit d'une diminution de sa saturation. De ce fait, les opérés perdent moins d'hématies mais plus de plasma au cours de l'intervention. La retransfusion du sang autologue prélevé est éffectuée en ordre inverse des prélévements sanguins dés que l'hémostase est assurée. La méthode est praticable et sans danger. Elle n'est pas en but aux problèmes logistiques posés par la transfusion de sang autologue prélevé avant la date de l'intervention et conservé. Elle a, pour avantage supplémentaire, le fait que le sang frais prélevé au début de l'intervention est disponible d'emblée pour la retransfusion. A condition que les contre-indications soient respectées, cette technique aide à réduire ou même à éviter les risques inhérents à la transfusion du sang homologue. Les besoins en sang conservé peuvent ainsi être réduits de 20% à 90% en fonction de l'intervention chirurgicale pratiquée.

Resumen

La hemodilución normovolémica preoperatoria fue introducida a la aplicación clínica por Messmer y colaboradores. La remoción preoperatoria de 1,500–2,000 ml mediante un intercambio isovolémico con coloides o con cristaloides (3 veces el volumen extraido), para mantener un volumen circulatorio constante, es compensado por el adecuado aumento en el gasto cardíaco y una mantenida capacidad sistémica de transporte de oxígeno a pesar del disminuido contenido de oxígeno. Los pacientes pierden menos globulos rojos y mayor cantidad de plasma intraoperatoriamente. La retransfusión de la sangre autóloga se hace en el orden inverso al de su recolección una vez que la hemostasis haya sido restablecida. El procedimiento representa un método seguro y factible que no se acompaña de los problemas logísticos del predepósito de la sangre autóloga y que posee la ventaja adicional que significa la disponibilidad inmediata de sangre autóloga para retransfusión. Teniendo en cuenta la debida observación a las contraindicaciones, esta tecnica ayuda a reducir, y aún a eliminar, los riesgos de la transfusión sangumea autóloga. La necesidad de sangre almacenada puede ser reducida en 20% a 90%, según el procedimiento quirúrgico.

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  1. Institute of Anesthesiology, Ludwig-Maximilians University, Marchioninistr. 15, 8000, Munich 70, Federal Republic of Germany

    Eike Martin M.D., Ernil Hansen M.D., Ph.D. & Klaus Peter M.D.

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  1. Eike Martin M.D.
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  2. Ernil Hansen M.D., Ph.D.
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Martin, E., Hansen, E. & Peter, K. Acute limited normovolemic hemodilution: A method for avoiding homologous transfusion. World J. Surg. 11, 53–59 (1987). https://doi.org/10.1007/BF01658460

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