MPACT OF PERI-OPERATIVE NORMOVOLEMIC HEMODILUTION ON HEMOSTASIS, BLOOD LOSS AND INDICATIONS TO TRANSFUSION OF DONOR ERYTHROCYTES DURING CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS

Intra-operative acute normovolemic hemodilution or autologous blood transfusion, is one of the factors of the patient's blood conservation and reduction of the donor blood use.

The objective: to assess the value of acute normovolemic hemodilution for the normalization of intra-operative homeostasis, reduction of blood loss and transfusion of donor erythrocytes during cardiac surgery with cardiopulmonary bypass.

Methods. 270 patients undergoing surgery on heart valves and coronary vessels at the age from 18 to 79 patients were examined. 600−1,200 ml of autoblood were collected before cardiopulmonary bypass against the background of the patient's heparinization and installation of aortic cannula. The following parameters were studied: the frequency of normovolemic hemodilution use, volume of autohemoexfusion of blood, hemostasis rates in the early post-perfusion period, the volume of intra- and post-operative blood loss, frequency and volume of hemotransfusion.

Results. Intra-operative autologous blood transfusion from right atrial appendage against full heparinization of the patient in the volume of 600–1,200 ml before cardiopulmonary bypass allowed reducing intra-operative blood loss by 1.3 times, the volume of transfused erythrocytes by 1.3–1.7 times and the frequency of the demand for it by 4–6 times in the patients having surgery with myocardial revascularization and cardiac defect management. The analysis of coagulation parameters in the post-perfusion period after modified acute normovolemic hemodilution proved the reduction of hemostasis dysfunction mostly due to the platelet factor.

Conclusion. Intra-operative acute normovolemic hemodilution is an effective and safe way to reduce intra-operative blood loss, use of donor blood and restoration of hemostasis in the patients undergoing cardiac surgery with cardiopulmonary bypass.

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