Application of Hypervolemic Hemodilution (HH) to Avoid Blood Transfusion

To avoid blood transfusion, we carried out hypervolemic hemodilution (HH) by rapid infusion of colloid solution without blood withdrawal in anemic patients. Nine patients who had Hb of less than 11g/dl, and normal cardiac and renal functions, underwent HH with Ringer's lactate and HES, and with...

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Published inNihon Rinshō Masui Gakkai shi Vol. 13; no. 7; pp. 648 - 653
Main Authors FUJII, Masayuki, OKUAKI, Akira, KONISHI, Akio, KIKUCHI, Keiko, TAMII, Hiromasa
Format Journal Article
LanguageEnglish
Published THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA 1993
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ISSN0285-4945
1349-9149
DOI10.2199/jjsca.13.648

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Abstract To avoid blood transfusion, we carried out hypervolemic hemodilution (HH) by rapid infusion of colloid solution without blood withdrawal in anemic patients. Nine patients who had Hb of less than 11g/dl, and normal cardiac and renal functions, underwent HH with Ringer's lactate and HES, and with hypotensive anesthesia induced by nitroglycerin. This procedure made it possible to avoid blood transfusion for all patients without any complications or any abnormalities in the blood coagulation system. The minimum value of Hct was 23% on avarage. We concluded that this preoperative HH was a very useful technique for avoiding blood transfusions in anemic patients. During acute hemodilution, however, excessive volume loading was associated with significant increases in CVP, PAP and PCWP. We must therefore select the operative cases who can most safely undergo HH, and should take scrupulous care concerning the sort of anesthetic technique and vasodilating therapy conducted during HH.
AbstractList To avoid blood transfusion, we carried out hypervolemic hemodilution (HH) by rapid infusion of colloid solution without blood withdrawal in anemic patients. Nine patients who had Hb of less than 11g/dl, and normal cardiac and renal functions, underwent HH with Ringer's lactate and HES, and with hypotensive anesthesia induced by nitroglycerin. This procedure made it possible to avoid blood transfusion for all patients without any complications or any abnormalities in the blood coagulation system. The minimum value of Hct was 23% on avarage. We concluded that this preoperative HH was a very useful technique for avoiding blood transfusions in anemic patients. During acute hemodilution, however, excessive volume loading was associated with significant increases in CVP, PAP and PCWP. We must therefore select the operative cases who can most safely undergo HH, and should take scrupulous care concerning the sort of anesthetic technique and vasodilating therapy conducted during HH.
Author FUJII, Masayuki
OKUAKI, Akira
TAMII, Hiromasa
KONISHI, Akio
KIKUCHI, Keiko
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  fullname: KONISHI, Akio
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  fullname: KIKUCHI, Keiko
  organization: Department of Anesthesiology, Fukushima Medical College
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  fullname: TAMII, Hiromasa
  organization: Department of Anesthesiology, Fukushima Medical College
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References 5) Trouwborst A, van Woerkens ECSM, van Daele M, et al.: Acute hypervolaemic haemodilution to avoid blood transfusion during major surgery. Lancet 336: 1295-1297, 1990
3) 新血液事業推進検討委員会:新血液事業推進検討委員会第二次報告(平成2年12月).日本輸血学会雑誌37: 467-474, 1991
4) Trouwborst A, Hagenouw RRPM, Jeekel J, et al.: Hypervolaemic haemodilution in an anaemic Jehovah's Witness. Br J Anaesth 64: 646-648, 1990
10) Wildsmith JA, Marshall RL, Jenkinson JL, et al.: Haemodynamic effects of sodium nitroprusside during nitrous oxide/halothane anaesthesia. Br J Anaesth 45: 71-74, 1973
9) Todd MM, Morris PJ, Moss J, et al.: Hemodynamic consequences of abrupt withdrawal of nitroprusside or nitroglycerin following induced hypotention. Anesth Analg 61: 261-266, 1982
14) 前田平生,東博彦,遠山博ほか:整形外科領域における自己血輸血を用いた手術施行者に対するエポチンベータ(EPOCH)の臨床評価-プラセボを対照とした二重盲検群間試験-.医学のあゆみ161: 163～176, 1992
6) 菊池恵子,民井宏昌,藤井真行ほか: Hypervolemic hemodilutionにおける血行動態についての検討。麻酔41: S403, 1992
8) Murray AV, Robert JA, Noble OF: Cardiovascular effects of anemia. Am Heart J 83: 415-426, 1972
13) 田崎哲典,遠山ゆり子,橋本長吉ほか:術前自己血輸血におけるエリスロポエチン投与基準設定の試み。日輸血会誌37: 484～490, 1991
1) 高折益彦,木村健一,遠藤恵美子:希釈式自己輸血と麻酔。麻酔38: 1627～1632, 1989
12) Goodnough LT, Rudnick S, Price TH, et al.: Increased preoperative collection of autologous blood with recombinant human erythropoietin therapy. New Engl J Med 321: 1163-1168, 1989
7) Takaori M, Safar P: Critical point in progressive hemodilution with hydroxyethyl starch. Kawasaki Med J 2: 212-222, 1976
2) 五十嵐孝,小沼利安,小西晃生ほか:希釈式自己血輸血(HAT)の有用性-整形外科人工関節置換術において-.日本臨床麻酔学会誌11: 92～99, 1991
11) 武田昭平,稲田豊,田代典子ほか:ニカルジピンによる低血圧麻酔の血行動態に及ぼす影響。麻酔39: 1586～1596, 1990
References_xml – reference: 2) 五十嵐孝,小沼利安,小西晃生ほか:希釈式自己血輸血(HAT)の有用性-整形外科人工関節置換術において-.日本臨床麻酔学会誌11: 92～99, 1991
– reference: 6) 菊池恵子,民井宏昌,藤井真行ほか: Hypervolemic hemodilutionにおける血行動態についての検討。麻酔41: S403, 1992
– reference: 1) 高折益彦,木村健一,遠藤恵美子:希釈式自己輸血と麻酔。麻酔38: 1627～1632, 1989
– reference: 4) Trouwborst A, Hagenouw RRPM, Jeekel J, et al.: Hypervolaemic haemodilution in an anaemic Jehovah's Witness. Br J Anaesth 64: 646-648, 1990
– reference: 13) 田崎哲典,遠山ゆり子,橋本長吉ほか:術前自己血輸血におけるエリスロポエチン投与基準設定の試み。日輸血会誌37: 484～490, 1991
– reference: 3) 新血液事業推進検討委員会:新血液事業推進検討委員会第二次報告(平成2年12月).日本輸血学会雑誌37: 467-474, 1991
– reference: 9) Todd MM, Morris PJ, Moss J, et al.: Hemodynamic consequences of abrupt withdrawal of nitroprusside or nitroglycerin following induced hypotention. Anesth Analg 61: 261-266, 1982
– reference: 8) Murray AV, Robert JA, Noble OF: Cardiovascular effects of anemia. Am Heart J 83: 415-426, 1972
– reference: 12) Goodnough LT, Rudnick S, Price TH, et al.: Increased preoperative collection of autologous blood with recombinant human erythropoietin therapy. New Engl J Med 321: 1163-1168, 1989
– reference: 7) Takaori M, Safar P: Critical point in progressive hemodilution with hydroxyethyl starch. Kawasaki Med J 2: 212-222, 1976
– reference: 14) 前田平生,東博彦,遠山博ほか:整形外科領域における自己血輸血を用いた手術施行者に対するエポチンベータ(EPOCH)の臨床評価-プラセボを対照とした二重盲検群間試験-.医学のあゆみ161: 163～176, 1992
– reference: 10) Wildsmith JA, Marshall RL, Jenkinson JL, et al.: Haemodynamic effects of sodium nitroprusside during nitrous oxide/halothane anaesthesia. Br J Anaesth 45: 71-74, 1973
– reference: 5) Trouwborst A, van Woerkens ECSM, van Daele M, et al.: Acute hypervolaemic haemodilution to avoid blood transfusion during major surgery. Lancet 336: 1295-1297, 1990
– reference: 11) 武田昭平,稲田豊,田代典子ほか:ニカルジピンによる低血圧麻酔の血行動態に及ぼす影響。麻酔39: 1586～1596, 1990
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Title Application of Hypervolemic Hemodilution (HH) to Avoid Blood Transfusion
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