Acute normovolemic hemodilution to reduce allogenic blood transfusion in patients undergoing radical cystectomy

Background:Allogenic blood transfusion is associated with a number of well-recognized risks and complications. We report here acute normovolemic hemodilution (ANH) to reduce allogenic blood transfusion during radical cystectomy. Methods : Forty five patients (hematocrit ≥35%, ASA status I - II) undergoing elective open radical cystectomy were investigated retrospectively by dividing into two groups, namely ANH group (group H ; n = 25), and control group (group C ; n=20). After induction of general anesthesia combined with epidural anesthesia, autologous whole blood (800-1600 ml) is collected in a series of collection bags (group H). When hemoglobin level dropped below the trigger (hemoglobin 7-8 g : dl ^-1) during surgery, allogenic blood transfu-sion (group C) and/or autologous blood transfusion (group H) were given. Results : No differences in intraoperative blood loss and urine volume between the two groups were observed. Nine patients in group C made use of allogenic blood transfusion (mean 570 ml). In contrast, no patients were given allogenic blood in group H. Two weeks after the operation, there was no difference in hemoglobin concentrations between the two groups and no serious complications occurred in all the patients studied. Conclusions : ANH may be effective in reducing the necessity of allogenic blood transfusion during radical cystectomy with a relatively large surgical blood loss.