British Journal of Anaesthesia, Vol 82, Issue 4 503-509, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia
P. Hobisch-Hagen, B. Wirleitner, J. Mair, G. Luz, P. Innerhofer, B. Frischhut, H. Ulmer and W. Schobersberger
Acute preoperative normovolaemic haemodilution (NHD) is an accepted tool
for reducing allogeneic blood transfusion requirements during surgery. At
present, little is known of its impact on haemostasis. We have investigated
the consequences of NHD on haemostasis by comparing conventional global
tests (prothrombin time (PT), activated partial thromboplastin time (aPTT)
with more specific measures of coagulation (prothrombin fragment 1 + 2 (F 1
+ 2), thrombin-antithrombin III complex (TAT) and fibrinolysis (D-dimer
(DD), plasmin-alpha 2- antiplasmin complex (PAP)). Blood samples were
collected from two groups (NHD and controls) undergoing elective spinal
surgery or pelvic osteotomy until day 3 after operation. The conventional
global tests remained within normal limits: there were no significant
differences between groups. Although surgery induced significant increases
in the more specific measures of coagulation and fibrinolysis, there were
no differences between NHD and control patients. Major orthopaedic surgery
strongly activates coagulation and fibrinolysis. As the degree of these
alterations was similar in haemodiluted and control patients, we suggest
that acute preoperative normovolaemic haemodilution itself does not appear
to be associated with greater perioperative disturbances in haemostasis.
CLINICAL INVESTIGATIONS
Consequences of acute normovolaemic haemodilution on haemostasis during major orthopaedic surgery
Clinic for Anaesthesia and General Intensive Care Medicine, Institute of Medical Chemistry and Biochemistry, Department of Orthopaedic Surgery, Institute of Biostatistics and Division for General and Surgical Intensive Care Medicine, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
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