Use of acute normovolemic hemodilution in patients undergoing radical prostatectomy.
OBJECTIVE
To evaluate the efficacy and safety of acute normovolemic hemodilution (ANH) in patients undergoing radical prostatectomy. Preoperative autologous blood donation (PAD) is widely accepted as a means of reducing the need for allogeneic blood transfusion in radical prostatectomy. ANH is an alternative method for obtaining autologous blood.


METHODS
On the basis of our previous report that showed the equivalence of PAD and ANH, we prospectively replaced PAD with ANH as a standard practice for radical prostatectomy after September 1999. Of 174 radical prostatectomy patients between September 1999 and June 2004, 153 underwent ANH alone, 15 chose to receive both PAD and ANH, and ANH was contraindicated in 15 because of comorbidities.


RESULTS
For the 153 patients undergoing ANH alone, 1032 +/- 201 mL of autologous blood was collected. With an intraoperative blood loss of 1602 +/- 926 mL, 14 patients (9.2%) received allogeneic blood transfusion. The preoperative, intraoperative nadir, and postoperative hematocrit value was 43.6% +/- 3.4%, 25.8% +/- 3.8%, and 31.9% +/- 4.3%, respectively. No patient experienced a perioperative adverse event related to hemodilution or blood transfusion.


CONCLUSIONS
Our continued experience has shown that ANH is a safe and effective means of autologous blood procurement. Given its advantages, including lower cost, lower risk, and simplicity, we conclude that ANH can replace conventional PAD for use in radical prostatectomy, although the true value of ANH should be determined by future randomized studies including a no-treatment control group.
Terai
Akito
A
Department of Urology, Kurashiki Central Hospital, Kurashiki, Japan. at7899@kchnet.or.jp
Terada
Naoki
N
Yoshimura
Koji
K
Ichioka
Kentaro
K
Ueda
Nobufumi
N
Utsunomiya
Noriaki
N
Kohei
Naoki
N
Arai
Yoichi
Y
Yonei
Akitomo
A
D000368:Aged; D016063:Blood Loss, Surgical; D001804:Blood Transfusion, Autologous; D001810:Blood Volume; D006400:Hematocrit; D006438:Hemodilution / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy