title: A randomized trial comparing acute normovolemic hemodilution and preoperative autologous blood donation in total hip arthroplasty.
abstract: BACKGROUND
  The value of acute normovolemic hemodilution (ANH) as compared to preoperative autologous blood donation (PABD) in orthopedic surgery is unknown. Therefore, a prospective, randomized study was conducted to compare these techniques in patients undergoing primary total hip arthroplasty.
  
  
  METHODS
  ANH patients underwent phlebotomy for up to 3 units, or to a target Hct level of 28 percent after induction of anesthesia. PABD patients were asked to donate up to 3 units before admission.
  
  
  RESULTS
  Mean baseline Hct levels were not different in ANH and PABD patients (39. 7 +/- 4.5 vs. 41.8 +/- 3.8%, p = 0.09). No difference was found in allogeneic blood exposure among ANH and PABD cohorts: 4 (17%) of 23 ANH patients received a total of 9 allogeneic blood units, compared to no allogeneic transfusions in the PABD cohort (p = 0.30). Total blood costs associated with ANH were significantly (p<0.05) lower than blood costs associated with PABD ($151 +/- 154 vs. $680 +/- 253, respectively).
  
  
  CONCLUSIONS
  In patients undergoing total hip arthroplasty, ANH is safe, can be considered equivalent to PABD in effectively reducing exposure to allogeneic RBCs, and is less costly than PABD.
authors.affiliation: Departments of Medicine and Pathology, Anesthesia, and Orthopedics, Washington University School of Medicine, St. Louis, Missouri 63110, USA. goodnough@labmed.wustl.edu
authors.forename: L T
authors.initials: LT
authors.lastname: Goodnough
authors.forename: G J
authors.initials: GJ
authors.lastname: Despotis
authors.forename: K
authors.initials: K
authors.lastname: Merkel
authors.forename: T G
authors.initials: TG
authors.lastname: Monk
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D001804:Blood Transfusion, Autologous / Q000191:economics; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D006438:Hemodilution / Q000191:economics / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome