Extracorporeal circulation as a blood conservation technique for extensive pelvic operations

Area of Science:

• Surgical Oncology
• Transfusion Medicine
• Anesthesiology

Background:

• Extensive blood loss is a risk in difficult pelvic surgeries for cancer or complex benign conditions.
• Patient refusal of homologous blood transfusions due to religious beliefs (e.g., Jehovah's Witnesses) or transfusion risks necessitates alternative strategies.
• Normovolemic hemodilution using cell salvage offers a potential method for blood conservation.

Purpose of the Study:

• To evaluate the efficacy and safety of using the Haemonetics-V50 Cell Separator for extracorporeal circulation and normovolemic hemodilution.
• To assess the feasibility of this blood conservation technique in patients undergoing extensive pelvic operations, particularly those who object to blood transfusion.
• To determine if this method can expand surgical options for patients with transfusion contraindications.

Main Methods:

• Utilized the Haemonetics-V50 Cell Separator for extracorporeal circulation and normovolemic hemodilution.
• Applied the technique in eight patients undergoing extensive pelvic operations.
• Monitored blood loss, transfusion requirements, and adverse events, including disseminated intravascular coagulation.

Main Results:

• The procedure was well-tolerated by all eight patients and accepted by Jehovah's Witnesses.
• Estimated blood loss varied significantly, ranging from 75 to 2,000 milliliters.
• One patient experienced mild intraoperative disseminated intravascular coagulation; two patients ultimately received homologous transfusions.

Conclusions:

• Normovolemic hemodilution with cell salvage is a useful technique for blood conservation during extensive pelvic surgery.
• This method can expand surgical possibilities for patients who decline blood transfusions.
• Careful clinical judgment remains essential for managing complex surgical cases and determining the safety of this technique.