Thrombelastography during an acute normovolemic hemodilution in patient undergoing radical retropubic prostatectomy

The aim of our study was to monitor a patient undergoing radical prostatectomy (RP) with an extraordinary large blood loss of 3600 ml. The perioperative bleeding was minimalized through an acute normovolemic hemodilution (ANH). During the procedure we monitored the patient's hemocoagulation profile. ANH is one of the possibilities for practical and pragmatic hemotherapy. It is a safe and effective method when facing massive blood loss or when it is necessary to temporarily replace or substitute the blood with a fluid during the operation (through a transfusion of allogeneic blood); and the patient benefits from the procedure. We argue that during ANH, the hypercoagulatory state appears in the patient--and even during the introduction of a combined solution of both crystalloids and colloids. In fact, during ANH it should not be recommended to provide a substitute for the patient's blood using only a single crystalloid solution alone (Tab. 2, Ref. 16).