Acute normovolemic hemodilution in sickle cell patient--a case report

Sickle cell disease patients with relatively high hemoglobin (> or = 12 g x dl) and those who have elevated alloimmunizations antibodies with rare phenotype subgroups, are problems challenging anesthesiologists. Acute Normovolemic Hemodilution (ANH) is rarely used in the perioperative management of homozygous sickle cell disease (SCD) in patients undergoing surgery. We hereby present a case in which ANH was used successfully. A 22 year old male patient with known homozygous sickle cell disease undergoing orthopedic surgery, underwent Acute Normovolemic Hemodilution (ANH) because of the absence of blood and suitable blood donors and high hemoglobin level. Just before establishing spinal anesthesia, a 400 ml blood was extracted from patient and then replaced by 6 % Hydroxyethylstarch HES solution.The surgery was performed uneventfully under spinal analgesia. Patient was discharged 48 hours later. A week later, his follow up visit showed no complications and his lab work returned to basic levels. We recommend the ANH technique as an on hand tool in the perioperative anesthetic management of sickle cell disease patients who have high Hb S with relatively high Hb levels, and in those special patients who have no blood available because of high alloimmunization antibodies or rare phenotype blood groups.