A randomized trial comparing acute normovolemic hemodilution and preoperative autologous blood donation in total hip arthroplasty.
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.
Goodnough
L T
LT
Departments of Medicine and Pathology, Anesthesia, and Orthopedics, Washington University School of Medicine, St. Louis, Missouri 63110, USA. goodnough@labmed.wustl.edu
Despotis
G J
GJ
Merkel
K
K
Monk
T G
TG
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