2004 Volume 18 Issue 3 Pages 179-187
The goal of “bloodless surgery” or the normovolemic hemodilution (NH) technique is to minimize intraoperative blood loss and to limit or eliminate preoperative blood donation and postoperative homologous transfusion. Risks associated with autologous or homologous blood transfusion include receiving the wrong unit, the potential for predonated blood contamination or infection in homologous blood, the progressive crenation of red corpuscles maintained over weeks prior to surgery, and the loss of coagulation factors and platelets. The NH technique was utilized in 40 patients averaging 49 years of age undergoing multilevel lumbar laminectomies with instrumented fusions. All patients had normal preoperative cardiac stress tests. Early in our series, 6 patients predonated from 1-3 units of blood ; the latter 34 patients did not. Immediately prior to surgery, an average of 563.5 cc of autologous blood was removed after which patients received an average of 4585 mL of crystalloid. Preoperative hematocrits averaged 41. Decompressive laminectomies (average 3.6 levels) and fusions (average 1.3 levels) required an average of 5.0 hours of operating time. Intraoperative blood loss (average 719 cc) resulted in average postoperative hematocrits of 27.5 five days postoperatively. Only 12 (30%) of 40 patients had enough autologous blood in the cell saver (average of 303 mL, range 100 cc-680 mL) to warrant reinfusion. Utilizing the normovolemic hemodilution technique, only 6 patients (15%) required postoperative homologous blood transfusions. For those wishing to predonate blood, more complete screening would allow unused units to be returned to the blood bank for use in the overall population.
