Acute Normovolemic Hemodilution in a Pregnant Patient with Carcinoma of the Ovary undergoing Cesarean
Abstract Number: 260
Abstract Type: Case Report/Case Series
Physicians continue to be motivated to find methods to reduce the use of allogenic blood. Even though donor screening has increased the safety of donated blood products, autologous blood is the most desirable source of red cells. There are numerous blood conservation techniques, aimed to reduce the need for banked blood transfusions.
We present a case of a 36 years pregnant patient, diagnosed with Ovarian CA, undergoing Cesarean Hysterectomy. No other significant history. Patient presented to the OR with a hematocrit of 36.6. Large bore intravenous catheters were introduced. General anesthesia was induced via Rapid sequence induction. Baby was delivered without any difficulty.
After the delivery of the baby, two units of PRBCs were collected into CPDA –1 coated blood collection bags. Simultaneously, fluid replacement with crystalloids was initiated. Patient tolerated the procedure well, remained hemodynamically stable. Received 4500ml of crystalloids. EBL was 2200 ml. End point hematocrit was 23.4. Patient was transfused the two units of autologous blood. Post transfusion Hematocrit was 28. Patient remained hemodynamically stable throughout the case. She was extubated and transferred to the recovery room. Patient had an uneventful post-op course. Patient did not require any further transfusions and was discharged home on post-op day 3.
Our hospital is a tertiary care center with a busy OB service- approximately 8000 deliveries per year. For efficient management of hemorrhage, a protocol was implemented, a conjoined effort by OB and Anesthesiology. Using OB simulator, hemorrhage management drills were initiated to train and educate the caregivers. These initiatives have significantly improved the awareness and efficiency in the management of the “Code H”. Very recently, a combined initiative sparked interest in how to conserve blood loss and use of blood and blood products in OB patients and a protocol has been created for the safe, appropriate use of ANH and Cellsaver. Acute normovolemic hemodilution is intentional intraoperative hemodilution induced by the with colloid or crystalloid solutions to preserve autologous blood while maintaining normovolemia, with the concept being a hemodiluted patient will lose a smaller portion of her red cell mass when compared with a patient with normal hematocrit. There is abundant evidence in the literature supporting the use of AIH in high risk obstetric patients. Limitations of AIH are a function of proper patient selection. Obviously AIH requires planning and not suitable for emergency cases.
Another concern that is often discussed in the context of AIH is the effect of the induced anemia on the fetus. Using fetal pH monitoring, as well as a variety of other techniques, it has been well documented in the literature—in both animal models as well as humans—that AIH does not negatively impact the fetus.