title: Acute normovolemic hemodilution and intraoperative cell salvage in aortic surgery.
abstract: OBJECTIVE
  The objective of this study was to report current transfusion requirements and outcomes in patients undergoing elective aortic surgery with autologous transfusion.
  
  
  METHODS
  This was a retrospective review of transfusion practice in infrarenal aortic surgery in a tertiary vascular unit with a longstanding interest in autologous transfusion. One hundred and ten consecutive patients underwent infrarenal aortic surgery with a combination of acute normovolemic hemodilution (ANH) and intraoperative cell salvage (ICS). All patients underwent hemodilution to a target hemoglobin concentration of 11 g/dL and underwent ICS with a centrifugal device.
  
  
  RESULTS
  Median blood loss was 1140 mL (interquartile range [IQR], 683 to 1609 mL) in 78 aneurysm repairs and 775 mL (IQR, 400 to 1225 mL) in 32 aortobifemoral bypasses for occlusive disease (P =.02), resulting in a median salvaged red cell volume of 403 mL (IQR, 256 to 563 mL) for aneurysm repairs and 250 mL (IQR, 200 to 290 mL) in bypass surgery (P =.001). Thirty-six patients (33%) needed transfusion of stored blood, for a total of 115 units, with just four patients needing more than five units. The mortality rate was 8% (9/110). With multivariate analysis, low hemoglobin level (P =.006) and low platelet count (P =.023) were associated with stored blood transfusion.
  
  
  CONCLUSIONS
  Blood loss is too small to justify ICS in surgery for occlusive disease; ANH alone may be a suitable strategy. With appropriate experience, the combination of ANH and ICS may render crossmatching unnecessary, even in aortic aneurysm surgery.
authors.affiliation: Academic Surgery Unit, Education and Research Centre, Wythenshawe Hospital, Manchester, United Kingdom.
authors.forename: Francesco
authors.initials: F
authors.lastname: Torella
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Haynes
authors.forename: Cliona C
authors.initials: CC
authors.lastname: Kirwan
authors.forename: Anand N
authors.initials: AN
authors.lastname: Bhatt
authors.forename: Charles N
authors.initials: CN
authors.lastname: McCollum
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000503:physiopathology / Q000628:therapy; D017545:Aortic Aneurysm, Thoracic / Q000503:physiopathology / Q000628:therapy; D016063:Blood Loss, Surgical; D001804:Blood Transfusion, Autologous; D001810:Blood Volume / Q000502:physiology*; D017558:Elective Surgical Procedures; D005260:Female; D006438:Hemodilution; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D016879:Salvage Therapy; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D006454:Hemoglobins