Acute Normovolemic Hemodilution Effects on Perioperative Coagulation in Elderly Patients Undergoing Hepatic Carcinectomy  

Background: Acute normovolemic hemodilution (ANH) has been widely used to prevent the massive bloodloss during hepatic carcinoma. The influences of ANH on coagulation function are still controversy, especiallyin elderly patients. The study observed ANH effects on coagulation function and fibrinolysis in elderly patientsundergoing the disease. Materials and
Methods: Thirty elderly patients (aged 60-70 yr) with liver cancer (ASAⅠ or Ⅱ) taken hepatic carcinectomy from February 2007 to February 2008 were randomly divided into ANHgroup (n=15) and control group (n=15). After tracheal intubation, patients in ANH group and control groupwere infused with 6% hydroxyethyl starch (130/0.4) and Ringer’s solution, respectively. Blood samples weredrawn from patients in both groups at five different time points: before anesthesia induction (T1), 30 min afterANH (T2), 1 h after start of operation (T3), immediately after operation (T4), and 24 h after operation (T5).Then coagulation function, soluble fibrin monomer complex (SFMC), prothrombin fragment (F1+2), and plateletmembrane glycoprotein (CD62P and activated GP IIb/GP IIIa) were measured.
Results: The perioperativeblood loss and allogeneic blood transfusion were recorded during the surgery. The perioperative blood loss wasnot significantly different between two groups (p>0.05), but the volume of allogeneic blood transfusion in ANHgroup was significantly less than in control group (350.0±70.7) mL vs. (457.0±181.3) mL (p<0.01). Comparedwith the data of T1, the prothrombin time (PT) and activated partial thromboplastin time (APTT) measuredafter T3 were significantly longer (p<0.05) in both groups, but within normal range. There were no significantchanges of thrombin time (TT) and D-dimer between two groups at different time points (p>0.05). SFMC andF1+2 increased in both groups, but were not statistically significant. PAC-1-positive cells and CD62P expressionsin patients of ANH group were significantly lower than those at T1 (p<0.05) and T2-T5 (p>0.05).
Conclusions:ANH has no obvious impact on fibrinolysis and coagulation function in elderly patients undergoing resection ofliver cancer. The study suggested that ANH is safe to use in elderly patients and it could reduce allogeneic bloodtransfusion.