Effects of blood volume restitution following a portal hypertensive-related bleeding in anesthetized cirrhotic rats.
The aim of this study was to investigate the influence of different strategies of blood volume restitution in the outcome of portal hypertension-related bleeding in anesthetized cirrhotic rats. Gastrointestinal hemorrhage was induced by sectioning a first order branch of the ileocolic vein in 38 cirrhotic rats (common bile duct ligation and occlusion). The subsequent hypovolemic shock was treated with no transfusion (n = 17), moderate transfusion (50% of expected blood loss, 5 mL, n = 11), and total transfusion (100% of expected blood loss, 10 mL, n = 10). At the end of the blood transfusion period (minute 15), mean arterial pressure (MAP) partially recovered in rats receiving moderate transfusion or no transfusion but decreased in the 10-mL transfusion group ( downward arrow 12 +/- 43%, P < .05 vs. no transfusion and 5 mL transfusion). After transfusion, groups given no or 5 mL transfusion remained hemodynamically stable. However, rats receiving 10 mL transfusion continued to deteriorate with persistent bleeding and progressive fall in MAP ( downward arrow 65 +/- 12%; P < .05 vs. no transfusion and 5 mL transfusion). Collected blood loss was significantly greater in the 10-mL group (20.0 +/- 1.5 g) than in groups given 5 mL (15.9 +/- 2.8 g; P < .05) or no transfusion (13.2 +/- 2.1 g; P < .05 vs. 10 mL and 5 mL transfusion). Survival in the no transfusion group was 47%. Rats given 5-mL transfusion had 64% survival. The worst survival was observed in the 10-mL transfusion group (0% survival; P < .05). We concluded that a transfusion policy aimed at completely replacing blood loss worsens the magnitude of bleeding and mortality from portal hypertensive-related bleeding in cirrhotic rats. On the contrary, moderate blood transfusion allowed hemodynamic stabilization and increased survival.
Hepatic Hemodynamic Laboratory, Liver Unit, IMD, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain.
B
B
Castañeda
J
J
Morales
R
R
Lionetti
E
E
Moitinho
V
V
Andreu
S
S
Pérez-Del-Pulgar
P
P
Pizcueta
J
J
Rodés
J
J
Bosch
D000818:Animals; D001803:Blood Transfusion / Q000379:methods; D001810:Blood Volume; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006975:Hypertension, Portal / Q000150:complications* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D051381:Rats; D017207:Rats, Sprague-Dawley; D016019:Survival Analysis