ORIGINAL ARTICLES   

Panminerva Medica 2000 September;42(3):211-5

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Effects of acute normovolaemic haemodilution and partial exchange transfusion on blood product utilization, haemostasis and haemodynamics in surgery of the thoracoabdominal aorta. A cohort study in consecutive patients

Cinà C. S., Clase C. M. *, Bruin G. **

From the Division of Vascular Surgery Department of Surgery *Department of Anaesthesia McMaster University, Hamilton, Canada **Division of Nephrology Department of Medicine Dalhousie University, Halifax, Canada

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Background. This paper outlines the technique of acute normovolaemic haemodilution with partial exchange transfusion (ANHPET) in surgery of the thoracic and thoracoabdominal aorta. Perioperative coagulation parameters and patterns of blood product utilization observed with this technique are described and compared with results for historical controls treated without ANHPET.
Methods. During thor­a­coab­dom­i­nal aneu­rysm ­repair, ­acute nor­mov­o­laem­ic hae­mod­i­lu­tion ­with par­tial ­exchange trans­fu­sion (ANH­PET) was ­used to with­draw­ of up to 3 L of ­blood. This was ­returned to the ­patient at the end of the recon­struc­tion. Albumin 5% and ­stored ­packed red ­cells (PRC) ­were ­used for replace­ment. Seven ­patients under­went sur­gery ­with ANH­PET, and fif­teen with­out. Univariate and mul­ti­var­i­ate anal­y­sis of var­i­ance was ­used to exam­ine dif­fer­enc­es ­between ­these ­groups.
Results. No dif­fer­enc­es ­were ­observed ­between the two ­groups for esti­mat­ed ­blood ­loss, PRC trans­fused, and ­postoper­a­tive hae­mog­lo­bin con­cen­tra­tion. The ANH­PET ­group ­received few­er plate­lets (8 vs 22 ­units, p=0.0004), cryop­re­cip­i­tate (0 vs 13 ­units, p=0.02), and desmo­pres­sin or epsi­lon-ami­no­ca­pro­ic ­acid (0 of 7 vs 4 of 15 ­patients, p=0.04). FFP use was not sig­nif­i­cant­ly dif­fer­ent (11 vs 17 ­units). Postoper­a­tive­ly, PTT val­ues ­were ­less pro­longed (26 vs 34 sec, p=0.05) and plate­let con­cen­tra­tion high­er (218 vs 169×109/L, p=0.01) in the ANH­PET ­group. A sig­nif­i­cant reduc­tion in the ­total of ­blood prod­ucts trans­fused was ­observed in the ANH­PET ­group (30 vs 68 ­units, p=0.003). Control of hyper­ten­sion was facil­i­tat­ed by phle­bot­o­my so ­that nitro­gly­ce­rine was nec­es­sary in low dos­es ­only (0.25 - 1.0 µg/kg/ min).
Conclusions. ANH­PET ­reduced ­blood prod­uct trans­fu­sion, ­improved post­op­er­a­tive haem­os­tat­ic param­e­ters and sim­pli­fied the man­age­ment of ­cross-clamp­ing hyper­ten­sion.