BACKGROUND: The value of acute normovolemic hemodilution (ANH) as compared
to preoperative autologous blood donation (PABD) in orthopedic surgery is u
nknown. Therefore, a prospective, randomized study was conducted to compare
these techniques in patients undergoing primary total hip arthroplasty.
STUDY DESIGN AND METHODS: ANH patients underwent phlebotomy for up to 3 uni
ts, or to a target Hct level of 28 percent after induction of anesthesia. P
ABD patients were asked to donate up to 3 units before admission.
RESULTS: Mean baseline Hct levels were not different in ANH and PABD patien
ts (39.7 +/- 4.5 vs. 41.8 +/- 3.8%, p = 0.09). No difference was found in a
llogeneic blood exposure among ANH and PABD cohorts: 4 (17%) of 23 ANH pati
ents received a total of 9 allogeneic blood units, compared to no allogenei
c transfusions in the PABD cohort (p = 0.30). Total blood costs associated
with ANH were significantly (p<0.05) lower than blood costs associated with
PABD ($151 +/- 154 vs. $680 +/- 253, respectively).
CONCLUSION: In patients undergoing total hip arthroplasty, ANH is safe, can
be considered equivalent to PABD in effectively reducing exposure to allog
eneic RBCs, and is less costly than PABD.