Impact of intraoperative normovolemic hemodilution on transfusion requirements for 68 patients undergoing lumbar laminectomies with instrumented posterolateral fusion.
METHODS
To determine whether the normovolemic hemodilution (NH) technique would limit postoperative homologous blood transfusion requirements in 68 patients having multilevel lumbar laminectomies (3-6 levels) with predominant 1- or 2-level instrumented fusions.


OBJECTIVE
In this setting, to define postoperative homologous blood transfusion requirements using NH.


BACKGROUND
NH limits postoperative homologous blood transfusion requirements following various types of surgical procedures including those on the spine.


METHODS
NH was used in an attempt to limit postoperative homologous transfusion requirements in 68 patients undergoing lumbar surgery. NH involves the removal of 1 to 2 U of blood replaced with crystalloid (2-4 mL per milliliter of blood harvested). Multiple variables contributing to homologous transfusion requirements were analyzed.


RESULTS
Using NH, no homologous blood transfusions were required in 52 patients with a mean preoperative hematocrit of 41.3 undergoing average 3.7 level laminectomies with 1.5 level fusions. However, 16 patients with an average preoperative hematocrit of 38.5 undergoing average 4.3 level laminectomies with 1.6 level fusions required transfusion of 31 U of homologous blood after surgery.


CONCLUSIONS
Using NH, 16 (23.5%) patients required 31 postoperative homologous blood transfusions. By contrast, the remaining 52 patients with similar procedures were able to avoid the use of homologous transfusion.
Epstein
Nancy E
NE
Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, NY, USA. dch3@columbia.edu
Peller
Abraham
A
Korsh
Jeff
J
DeCrosta
Don
D
Boutros
Ashray
A
Schmigelski
Carl
C
Greco
Joseph
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D005260:Female; D006438:Hemodilution / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007430:Intraoperative Care; D007796:Laminectomy; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion