Acute normovolemic hemodilution. Experimental and clinical study of coagulation

Testas, P.; Gallier de Saint Sauveur, V.; Martin, C.; Bach, B.; de Saint Sauveur, P.G.

Annales de l'Anesthesiologie Francaise 20(9): 797-804


ISSN/ISBN: 0003-4061
PMID: 45289
Accession: 068518817

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Normovolemic acute hemodilution (HAD) using the patient's own blood in reserve is an important method for decreasing peroperative blood transfusions. Numerous experimental and clinical studies have already been carried out concerning the various reactions to hemodilution: hemodynamics, tissue oxygenation, and oxygen transport capacity. Clinical and experimental experience with changes in coagulation during HAD were presented. Two studies were performed. One experiment involved 25 mongrel dogs, undergoing splenectomy 15 days before hemodilution. Amounts removed by venous section were compensated volume by volume by a modified fluid gelatin to obtain a stable hematocrit and blood volume during the experiment. The minimum hematocrit selected had a mean value of 13.9 .+-. 1.7 per 100. This hemodilution was continued for 24 h, the animal was then retransfused with its own blood in the form of packed cells. The 2nd study was the application of this experiment to human clinical use, involving 15 surgical patients. The hemodilution protocol was identical to that described elsewhere. Fluid compensation was also obtained using a modified fluid gelatin and retransfusion was carried out either post-operatively, or peroperatively if the minimum hematocrit was less than 20 per 100. For this clinical study, the minimum hematocrit was 26.8 .+-. 4 per 100 and the duration of hemodilution was thus limited to 4 or 5 h. Parameters studied were examined in parallel with the hematocrit level. During normovolemic acute hemodilution, using a modified fluid gelatin as a support, there was a dilution of clotting cofactors and of fibrinogen, as well as to a certain extent, the platelets. This fall in platelet count was partially compensated in human clinical use by out-flow from the spleen. Exogenous and endogenous thromboplastin formation, as well as fibrin formation remained possible, thereby permitting any type of surgical procedure without any risk of hemorrhage as a result of inadequate coagulation.