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KMID : 0378019810240070070
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New Medical Journal
1981 Volume.24 No. 7 p.70 ~ p.78
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Effects of Intraoperative Acute Normovolemic Hemodilution on Coagulation
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Abstract
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Prebleeding and hemodilution with saline, lactated Ringer´s solution, plasmanate, or dextran 70 have been used for major surgical procedures to avoid adverse effects of homologous transfusion and to conserve blood.
The effects of homodilution on hemodilution on hemodynamics and-oxygen transport to the tissues have been extensively studied. The effects on coagulation, however, have been seldom investigated.
The author has studied on the effects of intraoperative acute normovolemic hemodilution with dextran 40 and Hartmann´s solution upon coagulation in 14 patients undergoing total hip replacement. The mean blood volume bled from radial artery was 740 ml, equivalent to the estimated allowable blood hemodilution suggested by Bourke and Smith in 1974.
Prebled blood was retransfused to the patient toward the end of opetation. The mean ,operative blood loss was 1, 550ml, and 400m1(mean) of homologous blood was retransfused during the recovery phase if necessary to maintain the hematocrit level above 30%.
The results are as follows:
1. Hematocrit fell from the baseline mean of 40.5±3.000 to 32.1±1.7% immediately after hemQdilution, 32.4±2.100 half an hour after hemodilution, and to 34.2±3.4% at the end of operation (p<0.001).
2. There was a fall in fibrinogen, which persisted throughout the operation, from 326.1 ±29.3mg/100ml to 263.7±1.2mg/100ml immediately after hemodilution, to 247.6±20.7 mg/100ml half an hour after hemodilution, and to 250.5±21.3 mg/100ml at the end of operation (p<0.001) .
3. Platelet count fell, and persisted throughout the surgery. It fell from 236.1+39.2 (103/
mm3) to 210.8±36.2 (103/mm3) immediately following hemodilution, to 208.0±34.6 (103
/mm3) half an hour after hemodilution, and to 189.1±32.0 (103/mm3) at the end
procedure (p<0.001) .
4. Prothrombin time was prolonged slightly and remained prolonged. It was prolonged from 11.3±0.7 sec immediately following and 30 minutes after hemodilution, and 12.7 ± 1.0 sec at the end of operation (p<0. 001).
5. There was a greater prolongationn in activated partial thrombolastin time with gradual return toward normal. It was prolonged from 29.5±1.3 sec to 38.5±2.1 sec (p< 0.001) immediately after hemodilution, to 31.2±1.6 sec (p<0.001) 30 minutes after hemodilution, and to 29.7±1.6 sec p>0.05) at the end of operation.
6. Bleeding time was prolonged from 4.5±0.5 min to 9.5±1.2 min immediately after hemodilution, to 7.5±1.0 min 30 minutes after hemodilution, and to 7.0±1.1 min at the end of procedure (p<0.001).
7. Most of the abnormalities found with hemodilution by the author´s method resolved at the end of operation after reinfusion of the probled patient´s own blood. Prolonged bleeding time was not thought due to coagulation abnormalities, but to increased blood flow to cutaneous and muscular layers.induced by hemodilution.
8. It is concluded that intraoperative acute normovolemic hemodilution with dextran 40 and Hartmann´s solution and reinfusion of ;,autologotis blood is effective for patients undergoing major surgery.
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