Acute Normovolemic Hemodilution (ANH) impacts postoperative coagulation profile and bleeding in Adult Cardiac Surgery
DOI:
https://doi.org/10.47489/szmc.v38i2.471Keywords:
Acute normovolemic hemodilution, Cardiopulmonary Bypass, Drain output, Coagulation profile, Cardiac surgeryAbstract
Introduction: The coagulation profile of cardiac surgery patients is impacted by pro-inflammatory effects caused by procedures involving cardiopulmonary bypass. In order to counteract these effects, pharmacological therapies and allogeneic blood transfusions are required. The strategy of Acute normovolemic hemodilution also known as “intraoperative autologous donation” is also a viable option to address these negative effects. The theoretical basis for ANH is that the removed blood of a patient’s own self is shielded from the inflammatory response of blood cells to the bypass circuit. ANH is an infrequently practiced strategy at various cardiac surgery institutes within Pakistan to enhance coagulation profile, decrease the need for blood transfusions despite being an established approach abroad.
Aims and Objectives: The objective of our study is to compare the effect of ANH on patients undergoing adult cardiac surgery in a sample group versus a control group with the primary endpoint of postoperative drain output as a measure of effectiveness of blood coagulation profile. Blood coagulation profiles were also compared between the two groups as secondary variables.
Place and Duration of study: The study was conducted at the Faisalabad Institute of Cardiology from December 21st, 2023 to February 13th, 2024.
Material and Methods: A randomized controlled trial involving 60 patients over the age of 12 years who were to undergo adult cardiac surgery was conducted. An online research randomizer software randomly selected them into two equal groups, sample and control (n=30). The ANH volume retrieved from the patient's central vein in the sample group was used to fill the CPD blood transfusion bags after administering anesthesia. After the patients in both groups were weaned off CPB and protamine administered to neutralize heparin, ANH blood was infused back into the patients in the sample group whereas the control group received allogenic blood only. Chi square test was applied to all qualitative variables and Independent Samples t-test for all quantitative variables. The results were analyzed using SPSS version 25, and a p-value ? 0.05 was considered statistically significant.
Results: Hemoglobin (12.9±0.90 g/dL in ANH and 11.8±1.00 g/dL in non-ANH) and aPTT levels (34.2±6.06 seconds in ANH and 54.2±10.95 seconds in non-ANH) were statistically significant (p-value <0.01). In the ANH group, the mean value (623.3±86.28 mL) of postoperative drain output significantly decreased by approximately 220mL compared to the non-ANH group (842.3±99.26 mL) (p-value <0.01).
Conclusion: ANH positively conserves most of the coagulation profile parameters. It assists in reducing postoperative bleeding and the volume of allogeneic blood required perioperatively in cardiac surgery.
References
Shimoda T, Liu C, Mathis BJ. Effect of cardiopulmonary bypass on coagulation factors II, VII and X in a primate model: an exploratory pilot study. 2023;37(6).
Y?ld?z Z, Kay??n MA. Comparison of the effects of autologous and non-autologous blood transfusions on the advantages, disadvantages, extubation time and bleeding after coronary bypass. Heliyon. 2023;9(6):e17371.
Blumberg N, Heal JM. How do we forecast tomorrow's transfusion? - Next generation transfusion practices to improve recipient safety. Transfusion clinique et biologique : journal de la Societefrancaise de transfusion sanguine. 2023;30(1):31-4.
Smith BB, Nuttall GA, Mauermann WJ, Schroeder DR, Scott PD, Smith MM. Coagulation test changes associated with acute normovolemic hemodilution in cardiac surgery. 2020;35(5):1043-50.
Mladinov D, Padilla LA, Leahy B, Norman JB, Enslin J, Camp RS, et al. Hemodilution in high-risk cardiac surgery: Laboratory values, physiological parameters, and outcomes. Transfusion. 2022;62(4):826-37.
Zhou ZF, Jia XP, Sun K, Zhang FJ, Yu LN, Xing T, et al. Mild volume acute normovolemic hemodilution is associated with lower intraoperative transfusion and postoperative pulmonary infection in patients undergoing cardiac surgery -- a retrospective, propensity matching study. BMC anesthesiology. 2017;17(1):13.
Takahashi Y, Yoshii R, Amaya F, Sawa T, Ogawa
S. Effect of acute normovolemic hemodilution in patients undergoing cardiac surgery with remimazolam anesthesia. 2023.
Ereth MH, Oliver WC, Jr., Santrach PJ. Perioperative interventions to decrease transfusion of allogeneic blood products. Mayo Clinic proceedings. 1994;69(6):575-86.
Frank SM, Abazyan B, Ono M, Hogue CW, Cohen DB, Berkowitz DE, et al. Decreased erythrocyte deformability after transfusion and the effects of erythrocyte storage duration. Anesthesia and analgesia. 2013;116(5):975-81.
Sousa RS, Minervino AHH. Impact of blood storage duration on hematologic, blood gas, biochemical, and oxidative stress variables in sheep undergoing allogeneic blood transfusions. 2020;49(4):545-56.
Kusudo E, Murata Y, Matsumoto T, Kawamoto S. Platelet function of whole blood after short-term cold storage: A prospective in vitro observational study. 2023;63(2):384-92.
Barile L, Fominskiy E, Di Tomasso N, Alpìzar Castro LE, Landoni G, De Luca M, et al. Acute Normovolemic Hemodilution Reduces Allogeneic Red Blood Cell Transfusion in Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Trials. Anesthesia and analgesia. 2017;124(3):743-52.
Rhee P, Inaba K, Pandit V, Khalil M, Siboni S, Vercruysse G, et al. Early autologous fresh whole blood transfusion leads to less allogeneic transfusions and is safe. The journal of trauma and acute care surgery. 2015;78(4):729-34.
Henderson RA, Judd M, Strauss ER, Gammie JS, Mazzeffi MA. Hematologic evaluation of intraoperative autologous blood collection and allogeneic transfusion in cardiac surgery. 2021;61(3):788-98.
Yoshinaga K, Iizuka Y, Sanui M, Faraday N. Low- Volume Acute Normovolemic Hemodilution Does Not Reduce Allogeneic Red Blood Cell Transfusion in Cardiac Surgery in the Modern Era of Patient Blood Management: A Propensity Score-Matched Cohort Study. Journal of cardiothoracic and vascular anesthesia. 2023
Casati V, Speziali G, D'Alessandro C, Cianchi C, Antonietta Grasso M, Spagnolo S, et al. Intraoperative low-volume acute normovolemic hemodilution in adult open-heart surgery. Anesthesiology. 2002;97(2):367-73.
Mladinov D, Eudailey KW, Padilla LA. Effects of acute normovolemic hemodilution on post- cardiopulmonary bypass coagulation tests and allogeneic blood transfusion in thoracic aortic repair surgery: An observational cohort study. 2021;36(11):4075-82.
Crescini WM, Muralidaran A, Shen I, LeBlan A, You J, Giacomuzzi C, et al. The use of acute normovolemic hemodilution in paediatric cardiac surgery. Acta anaesthesiologica Scandinavica. 2018;62(6):756-64.
Sebastian R, Ratliff T, Winch PD, Tumin D, Gomez D, Tobias J, et al. Revisiting acute normovolemic hemodilution and blood transfusion during pediatric cardiac surgery: a prospective observational study. Paediatricanaesthesia. 2017;27(1):85-90.
Li Y, Zhang Y, Fang X. Acute normovolemic hemodilution in combination with tranexamic acid is an effective strategy for blood management in lumbar spinal fusion surgery. Journal of orthopaedic surgery and research. 2022;17(1):71
Lin HS, Samy RN, Lum J, Dorie MJ, Terris DJ. Effect of blood transfusion in an experimental sarcoma model. Archives of otolaryngology--head & neck surgery. 2002;128(3):308-12.
Cohn, L. 2018. Cardiac Surgery in the Adult (5th edition, page 352). McGraw-Hill Education
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Proceedings
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a 