Acute normovolemic hemodilution in major orthopedic surgery

With increasing concerns regarding the newer emerging pathogens, alternatives to allogeneic blood transfusion are being explored and acute normovolemic hemodilution (ANH) is one of them.

A prospective study was conducted in patients aged 18-65 years with preoperative hemoglobin >12 g/dl undergoing total knee replacement or total hip replacement. Patients in whom hemodilution was performed were included in the ANH group whereas patients undergoing treatment as per the routine hospital protocol were included in the control group.

Preoperative hemoglobin was similar in both ANH and control groups (12.7 ± 0.7 vs 12.6 ± 0.6, p = 0.56). Allogeneic blood requirement was significantly less in the ANH group as compared to the control group (4 vs 15, p = 0.001). Postoperative complications were significantly lower in ANH group as compared to control group (7 vs 16, p = 0.01).

ANH can be an alternative approach to meet the need of safe blood especially in resource constrained countries, like India where risk of transfusion transmitted infections are still high and where there is high demand of blood and acute shortage of blood in hospitals.