The Relationship between Hemoglobin Level before Acute Normovolemic Hemodilution and Nadir Level of Hemoglobin during Cardiopulmonary By-pass in Elective Coronary Artery Bypass Graft Surgery

Document Type : Original Article(s)

Authors

1 Assistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University

2 Student of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

Background: Current data suggests that basal hemoglobin of 12 mg/dl is suitable for practicing Acute Normovolemic Hemodilution (ANH), during operations not necessitating cardiopulmonary bypass. This level seems to be too low when using CPB, complicating this procedure.Methods: To study the relationship between Hb level before ANH and baseline level of hemoglobin, 581 patients were investigated during cardiopulmonary bypass in elective coronary artery bypass graft (CABG) surgery. Convenient sampling method was used. Repeated measurements of hemoglobin level were done during the operation.Finding: The mean of baseline hemoglobin, first hemoglobin after going on-pomp, nadir hemoglobin during pomp, and hemoglobin during pomp for patients underwent ANH was 15.18, 8.38, 7.8 and 8.2 mg/dl respectively and 13.1, 7.7, 7.2, and 7.6 mg/dl for patients who did not undergo ANH. There was significant correlation between basal and first Hb hemoglobin going on-pomp, nadir hemoglobin during pomp and mean hemoglobin during pomp in both ANH and no-ANH groups (P < 0.001). There was significant difference between results of current formula to predetermine nadir hemoglobin, and our actual nadir hemoglobin obtained from patients. Minimum level of suitable basal hemoglobin for practicing ANH (450 ml) during on-pomp CABG, was calculated to be 14.55 mg/dl (sensitivity: 77%, specificity: 70%, and AUC: 0.805) and 12.95 mg/dl (sensitivity: 71%, specificity: 64%, and AUC: 0.686) for on-pomp CABG without ANH.Conclusion: Basal hemoglobin for practicing ANH during on-pomp surgery, somehow, depends on threshold hemoglobin for blood transfusion and acceptance of advantages and disadvantages of ANH and its complications by physician and patient.

Keywords

References

  1. Goodnough LT, Monk TG. Autologous transfusion. In: Miller RD, Editor. Miller's anesthesia. Philadelphia: Elsevier/Churchill Livingstone, 2005. p. 1831-44.
  2. Weiskopf RB. Efficacy of acute normo-volemic hemodilution assessed as a function of fraction of blood volume lost. Anesthesiology 2001; 94(3): 439-46.
  3. Casati V, Speziali G, D'Alessandro C, Cianchi C, Antonietta GM, Spagnolo S, et al. Intraoperative low-volume acute normovolemic hemodilution in adult open-heart surgery. Anesthesiology 2002; 97(2): 367-73.
  4. Goodnough LT, Despotis GJ. Blood transfusion and blood conservation. In: Gravlee GP, Davis RF. Editors. Cardi-opulmonary bypass: principles and practice. Philadelphia: Lippincott Williams & Wilkins, 2000. p. 534-46.
  5. Moskowitz DM, Klein JJ, Shander A, Cousineau KM, Goldweit RS, Bodian C, et al. Predictors of transfusion requirements for cardiac surgical procedures at a blood conservation center. Ann Thorac Surg 2004; 77(2): 626-34.
  6. Bryson GL, Laupacis A, Wells GA. Does acute normovolemic hemodilution reduce perioperative allogeneic transfusion? A meta-analysis. The International Study of Perioperative Transfusion. Anesth Analg 1998; 86(1): 9-15.
  7. Singbartl K, Innerhofer P, Radvan J, Westphalen B, Fries D, Stogbauer R, et al. Hemostasis and hemodilution: a quantitative mathematical guide for clinical practice. Anesth Analg 2003; 96(4): 929-35, table.
  8. Ickx B, Van der Linden P. Interactions entre les solutes colloides et l'hemostase. Sang Thrombose Vaisseaux 2002; 14(7): 408-16.
  9. Mahoori A, Heshmati F, Noroozinia H, Me-hdizadeh H, Salehi S, Rohani M. Intraoperative minimal acute normovolemic hemodilution in patients undergoing coronary artery bypass surgery. Middle East J Anesthesiol 2009; 20(3): 423-29.
  10. Linden MD, Schneider M, Erber WN. Acute normovolemic hemodilution does not reduce antithrombin concentration for cardiac surgery. J Thromb Thrombolysis 2004; 17(3): 173-6.
  11. Riley JB, Samolyk KA, Bryan V, Moskowitz D, Shander A. Results from the Perfusion.com Cardiac Surgery Hematocrit Trend Survey: Observations and Evidence-Based Recommendations. Survey report [Online]. 2006 [cited 2006 Jan 14]; Available from: URL:
  12. http://www.perfusion.com/
  13. Ranucci M, Biagioli B, Scolletta S, Grillone G, Cazzaniga A, Cattabriga I, et al. Lowest hematocrit on cardiopulmonary bypass impairs the outcome in coronary surgery: An Italian Multicenter Study from the National Cardioanesthesia Database. Tex Heart Inst J 2006; 33(3): 300-5.
  14. Moor RA, Laub GW. Hemofiltration, dialysis, and blood salvage techniques during cardiopulmonary bypass. In: Gravlee GP, Davis RF. editors. Cardiopulmonary bypass: principles and practice. Philadelphia: Lippincott Williams & Wilkins, 2000. p. 105-30.
  15. Rinder CS. Hematologic effects of cardiopulmonary bypass. In: Gravlee GP, Davis RF, Editors. Cardiopulmonary bypass principles and practice. Philadelphia: Lippincott Williams & Wilkins, 2000. p. 492-505.
  16. Horrow JC, Fitch JC. Management of coagulopathy associated with cardi-opulmonary bypass. In: Gravlee GP, Davis RF, Editors. Cardiopulmonary bypass principles and practice. Philadelphia: Lippincott Williams & Wilkins, 2000. p. 506-33.
  17. Fang WC, Helm RE, Krieger KH, Rosengart TK, DuBois WJ, Sason C, et al. Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery. Circulation 1997; 96(9 Suppl): II-9.
  18. DeFoe GR, Ross CS, Olmstead EM, Surgenor SD, Fillinger MP, Groom RC, et al. Lowest he-matocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group. Ann Thorac Surg 2001; 71(3): 769-76.
  19. Karkouti K, Beattie WS, Wijeysundera DN, Rao V, Chan C, Dattilo KM, et al. Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery. J Thorac Cardiovasc Surg 2005; 129(2): 391-400.
  20. Karkouti K, Djaiani G, Borger MA, Beattie WS, Fedorko L, Wijeysundera D, et al. Low hematocrit during cardiopulmonary bypass is associated with increased risk of perioperative stroke in cardiac surgery. Ann Thorac Surg 2005; 80(4): 1381-7.
  21. Cooper JR, Giesecke NO. Hemodilution and priming solutions. In: Gravlee GP, Davis RF, Editors. Cardiopulmonary bypass principles and practice. Philadelphia: Lippincott Williams & Wilkins, 2000. p. 186-96.
  22. Van der Linden P. Acute normovolemic anemia: physiological and practical concerns. Jurnalul de Chirurgie, Iasi 2007; 3(3): 230-7.
  23. Segal JB, Blasco-Colmenares E, Norris EJ, Guallar E. Preoperative acute normovolemic hemodilution: a meta-analysis. Transfusion 2004; 44(5): 632-44.
  24. Dietrich W, Barankay A, Dilthey G, Mitto HP, Richter JA. Reduction of blood utilization during myocardial revascularization. J Thorac Cardiovasc Surg 1989; 97(2): 213-9.
  25. Herregods L, Moerman A, Foubert L, Den Blauwen N, Mortier E, Poelaert J, et al. Limited intentional normovolemic hemodilution: ST-segment changes and use of homologous blood products in patients with left main coronary artery stenosis. J Cardiothorac Vasc Anesth 1997; 11(1): 18-23.
  26. Kahraman S, Altunkaya H, Celebioglu B, Kanbak M, Pasaoglu I, Erdem K. The effect of acute normovolemic hemodilution on homolo-gous blood requirements and total estimated red blood cell volume lost. Acta Anaesthesiol Scand 1997; 41(5): 614-7.
  27. Habler O, Schwenzer K, Zimmer K, Prager M, Konig U, Oppenrieder K, et al. Effects of standardized acute normovolemic hemodilution on intraoperative allogeneic blood transfusion in patients undergoing major maxillofacial surgery. Int J Oral Maxillofac Surg 2004; 33(5): 467-75.
  28. Brecher ME, Rosenfeld M. Mathematical and computer modeling of acute normovolemic hemodilution. Transfusion 1994; 34(2): 176-9.
  29. Weiskopf RB. Mathematical analysis of isovo-lemic hemodilution indicates that it can decrease the need for allogeneic blood transfusion. Transfusion 1995; 35(1): 37-41.
Journal of Isfahan Medical School
Volume 28, Issue 117 - Serial Number 117
November and December 2011
Pages 1194-1204

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History

  • Receive Date: 19 March 2011
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

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