A prospective study to evaluate the effects of acute normovolemic hemodilution on perioperative homologous transfusion requirements in patients undergoing major surgery

Ajay Kumar, Shalendra Singh, Parmeet Bhatia, Bhavna Hooda, Priya Taank


Background: Acute Normovolemic Hemodilution (ANH) and autologous transfusion can mitigate the harmful effects of banked blood intraoperatively. This study was planned to evaluate its effects on perioperative transfusion requirement, hemodynamic stability and safety profile.

Methods: Hundred patients were randomized to Group 1, where assigned patients received ANH and autologous transfusion after hemostasis; and Group II where assigned patients received homologous transfusion. In group I, 350 to 700 ml of patient's blood was collected before induction of anaesthesia and was kept in the operation theatre at room temperature. This was followed by rapid infusion of calculated Hetastarch. Intraoperative blood loss, amount of transfused blood, serial haemoglobin (Hb) assessment, and change in hemodynamics were carefully monitored. The blood was reinfused once hemostasis was secured at the end of surgery.

Results: It was observed that hemodynamic stability was maintained in both the groups during and after haemodilution. There was no significant change in bleeding and clotting time due to haemodilution. The mean intra-operative blood loss in both groups was comparable. 350 mL and 700 mL blood withdrawn in 27 and 23 patients and 500mL and 1000 mL HES infused respectively. There was an average fall in the mean Hb level by 1.74 gm % and in the mean haematocrit (Hct) level by 6.4 % after haemodilution. The mean 12th and 24th hour Hb and Hct levels were comparable. The requirement of homologous blood transfusion in group I was significantly low (p<0.0001). Need for homologous transfusion was 0.72 per patient treated in the Group I.

Conclusions: Acute normovolemic hemodilution is a simple, safe and effective modality to reduce perioperative transfusion of banked blood and should be considered in patients undergoing surgical procedures where major blood loss is expected.


Acute normovolaemic haemodilution, Auto transfusion, Blood loss, Blood transfusion, Hetastarch

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Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) Working Party. Recommendations for the transfusion management of patients in the peri-operative period. II. intra-operative period. Blood Transfus. 2011;9(2):189-217.

The LH. Updates on blood transfusion guidelines. T Lancet. 2016 Dec;3(12):e547.

Vassallo R, Goldman M, Germain M, Lozano M, Collaborative BE. Preoperative autologous blood donation: waning indications in an era of improved blood safety. Transfusion Med Rev. 2015 Oct 1;29(4):268-75.

Mehta SP: Intraoperative haemodilution and auto transfusion in major cancer surgery. Med J Armed Forces J. 1991;47:1.

Manickam L, Korula N, Idikula J, Pulimood R. Normovolemic haemodilution with and without autologous blood transfusion during major elective surgery. Natl Med J India. 1991 Sep-Oct;4(5):212-5.

Damyanti S, Shirolkar SP, Udvadia T, Dafter M. Preoperative Haemodilution with hamaccel and auto transfusion in major general surgery Ind J Inter Med. 1991;1(6):131-7.

Krämer AH, Hertzer NR, Beven EG. Intraoperative hemodilution during elective vascular reconstruction. Surg, Gynecol Obstetr. 1979 Dec;149(6):831-6.

Rai S, Verma S, Yadav PK, Ahmad J, Yadav HK. Utility of acute normovolemic hemodilution in major surgeries in rural area: A prospective comparative study from North India. Anesth, Essays Res. 2017 Oct;11(4):909.

Watzek G, Watzek C, Draxler V, Fürnschlief E. Experience with “isovolaemic” haemodilution in extensive surgery for oro-facial tumours. J Maxill Surg. 1980 Jan 1;8:131-4.

Ruttmann TG, James MF, Viljoen JF. Haemodilution induces a hypercoagulable state. Bri J Anaesth. 1996 Mar 1;76(3):412-4.