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Rethinking Transfusion Strategies in CABG: Acute Normovolaemic Haemodilution versus Conventional Transfusion: A
Diyan Muhammad1, Taimur Asif Ali1, Muhammad Anas Khan2
1Department of Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, Pakistan.
Abstract:
Coronary artery bypass grafting (CABG) is among the most commonly performed cardiac surgical procedures worldwide and frequently requires perioperative blood transfusion. Acute normovolaemic haemodilution (ANH) is a simple and economical strategy that aims to reduce the need for allogeneic blood transfusion. A systematic review was conducted between October 2024 and August 2025 and analysed randomised controlled trials comparing ANH with conventional transfusion practices in patients undergoing coronary bypass surgery. Eighteen studies were evaluated for outcomes such as transfusion rates, blood loss, coagulation profiles, myocardial protection, postoperative complications, and cost-effectiveness. ANH reduced the need for allogeneic blood transfusion without affecting haemodynamic stability or postoperative recovery. Moderate improvements were observed in coagulation preservation and myocardial protection, although the certainty of evidence varied across outcomes. Further large-scale trials are required to establish standardised ANH protocols and clarify long-term clinical outcomes. Key Words: Acute normovolaemic haemodilution, Coronary artery bypass grafting, Blood conservation, Allogeneic transfusion.
