Acute Normovolemic Hemodilution for Management of Blood Loss during Radical Cystectomy - Case Report

Overview

Blood loss is an inevitable consequence of surgery. We refer a case report of patient with high cardiac risk (ASA classification III), in which weused acute normovolemic hemodilution as a solely method for avoiding of allogenic blood transfusions. After starting general anaesthesia we removed2 500 g of whole blood from patient with restoration of circulation volume by 1 500 ml of colloids and 2 000 ml of crystalloids. Retransfusion we startedafter 800 ml blood loss (transfusion trigger - Hct 0,20). The general blood loss was 3 500 ml during 6 hour and 40 minutes of operation time and next880 ml in 48 hours postoperatively. The patient was the whole time hemodynamic stable, with mi nimal systolic blood pressure 100 mmHg and endinghematocrit value 0,26. To reduce the risk of anaemia and also the risk of allogeneic transfusion is the one of the basic part of the anaesthesiamanagement of large urological procedures. This case demonstrated the effectiveness and safety of acute normovolemic hemodilution as a method foravoiding of allogeneic blood transfusion in patient with high anaesthesiological risk.

Key words:
acute normovolemic hemodilution - large blood loss - cardiac risk patient