title: Techniques for hepatectomies without blood transfusion, focusing on interpretation of postoperative anemia.
abstract: OBJECTIVE
  Transient postoperative anemia is partially a physiologic phenomenon, and variations in blood transfusion rates after liver resection in different series in part are due to different interpretations of postoperative anemia. Based on the hypothesis that transient postoperative anemia is partially a physiologic phenomenon, we analyzed serum hemoglobin and hematocrit values in patients who underwent liver resection without blood transfusion to check fluctuations.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Community hospital.
  
  
  METHODS
  Forty-six consecutive patients with primary and metastatic liver tumors.
  
  
  METHODS
  Surgical treatment consisting of dissection technique performed under intermittent warm ischemia, using intraoperative ultrasonography, and without blood transfusion.
  
  
  METHODS
  Hematocrit and hemoglobin concentrations in serum sampled preoperatively and on the first, third, fifth, and seventh postoperative days.
  
  
  RESULTS
  No postoperative mortality and major morbidity were observed. No patient received a blood transfusion. The hematocrit and hemoglobin concentrations in serum were significantly lower on the third postoperative day than on the first, fifth, and seventh postoperative days; differences among the first, fifth, and seventh postoperative days were not significant.
  
  
  CONCLUSIONS
  The fluctuations of hemoglobin and hematocrit levels after liver resection showed a steady and significant decrease until the third postoperative day and then an increase. Therefore, a decrease in the hemoglobin and hematocrit levels between first and fifth postoperative days without evidence of active bleeding from drain discharge or any other possible source of bleeding does not justify blood administration.
authors.affiliation: Hepatobiliary Surgery Unit, First Department of Surgery, Ospedale Maggiore di Lodi, Azienda Ospedaliera della Provincia di Lodi, I-26900 Lodi, Italy. guido.torzilli@fastwebnet.it
authors.forename: Guido
authors.initials: G
authors.lastname: Torzilli
authors.forename: Andrea
authors.initials: A
authors.lastname: Gambetti
authors.forename: Daniele
authors.initials: D
authors.lastname: Del Fabbro
authors.forename: Piera
authors.initials: P
authors.lastname: Leoni
authors.forename: Natale
authors.initials: N
authors.lastname: Olivari
authors.forename: Matteo
authors.initials: M
authors.lastname: Donadon
authors.forename: Marco
authors.initials: M
authors.lastname: Montorsi
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology / Q000209:etiology*; D001803:Blood Transfusion; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies