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Acute normovolemic hemodilution to a hemoglobin of 7.8 g/dL prior to cesarean hysterectomy in a Jehovah's Witness with placenta percreta, with PulseCO hemodynamic monitoring.
Abstract Number: 225
Abstract Type: Case Report/Case Series
A 34 year old Jehovah's Witness with complete placenta previa had a preoperative hemoglobin of 10.9 g / dL. In the operating room, prior to cesarean hysterectomy, acute normovolemic hemodilution (ANH) was performed, withdrawing 2100 mL of blood and reducing the patient's hemoglobin to 7.8 g/dL, without evidence of fetal distress based on fetal heart rate monitoring.
An uneventful cesarean hysterectomy was performed with an estimated blood loss of 1000 mL. All of the ANH blood was returned to the patient once hemostasis had been achieved.
The patient's hemoglobin was 9.0 g/dL on the first postoperative day. PulseCO monitoring of an arterial line pressure tracing was used to follow hemodynamic trends during the procedure.
Acute normovolemic hemodilution to a packed cell volume (PCV) of 31% has been reported prior to cesarean hysterectomy (1), and our group has reported another case of hemodilution to a Hg of 10.2 g/dL (2), but no guidelines exist as to how much maternal hemodilution the fetus can tolerate for the short time period between ANH and delivery.
Substantial hemodilution increases the value of the technique (3), but prior to cesarean section, excessive ANH could cause severe maternal anemia and fetal distress. To our knowledge ANH to a Hg as low as 7.8 g/dL has not been previously reported prior to cesarean delivery.
Because of the brief period of maternal anemia prior
to delivery, it may be acceptable to induce marked maternal hemodilution in circumstances such as those of this case, in which potential blood loss is considerable and allogeneic transfusion and preoperative autologous donation are not possible due to religious beliefs.