Pre-operative blood donation versus acute normovolemic hemodilution in cardiac surgery

Acute normovolemic hemodilution (ANH) and preoperative autologous blood donation (PABD) have questionable efficacy, viral and bacterial infection risks, intermittent blood shortages as homeostasis problem, electrolyte and hemodynamic disturbances.

In this cross sectional survey, we studied 70 patients undergoing open heart coronary artery bypass grafts [CABG] and different valvular replacement 1 ml surgery (35 in ANH, 35 in PABD) in Shaheed Modares - Hospital. We measured electrolytes and homeostatic factors to evaluate the influence of two transfusion methods on homeostatic function and hemodynamic balance.

We compared 70 patients (38 male [54.3%] and 32 female [45.7%]) with mean age 54.8 years undergoing open heart surgery (CABG and valvular). In ANH group, significant decrease was detected in Na (28.5%) K (2.5%), prothrombin time (PT) (88.57%), partial thromboplastin time (PTT) (94.28%), creatine phosphokinase (CPK) (11.4%), lactic dehydrogenase (LDH) (11.43%), albumin (Alb) (17.14%), globulin (91.43%) and total protein (80%). Mean initial and post-operative hemoglobin was 14.12 ± 1.06 versus 11.97 ± 0.98, hematocrit 42.22 ± 3.45 versus 35.40 ± 2.88, systolic blood pressure 124.1 ± 14.4 versus 110.88 ± 15.6 (reduction 22.86%) diastolic blood pressure 76.02 ± 10 versus 69.26 ± 11 (reduction 3%) and pulse rate was 75.45 ± 10 versus 84.45 ± 12 (12%) in this case difference between two groups was strongly significant (P = 0.001). In PABD group, significant decrease was detected in Na (20%), K (2.5%), PT (91.43%) PTT (80%), CPK (8.57%), LDH (5.72%), Alb (57.15%), globulin (71.43%) and total-protein (62.85%), the value of hemodynamic changes were in normal range.

Though autologous blood transfusion (ANH and PABD) was preferable to allogeneic transfusion in cardiac surgical patients; but PABD offers more advantages in homeostasis, hemodynamic stability and electrolyte balance.