3.6 Effect of perioperative strategies that minimise blood loss

3.6.5 Acute normovolemic haemodilution

The detailed findings of the systematic review for this intervention can be found in Section 3.1.1 of Volume 1b of the technical report.4 The systematic review process identified 5 Level I studies146,173-176 and 14 Level II studies177–190 (RCTs) of variable quality that assessed the effect of acute normovolemic haemodilution (ANH) in patients undergoing surgery.

Transfusion requirements

A meta-analysis demonstrated that, overall, the incidence and volume of allogeneic blood transfusion were significantly lower for patients who received ANH. However, methods of ANH differed between studies, and the results were not consistent for all types of surgery studied.

EVIDENCE STATEMENTS – acute normovolemic haemodilution	Evidence	Consistency	Clinical impact	Generalisability	Applicability
In adult patients undergoing surgery in which substantial blood loss is anticipated, ANH reduces the incidence of allogeneic blood transfusion.
In adult patients undergoing surgery in which substantial blood loss is anticipated, ANH may reduce the volume of allogeneic blood transfusion.
I n adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of ANH on blood loss is uncertain.			X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of ANH on mortality is uncertain.			X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of ANH on morbidity is uncertain.			X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of ANH on quality of life is unknown.	NA	NA	NA	NA	NA
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of ANH on postoperative haemoglobin concentration is uncertain.			X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of ANH on risk of reoperation for bleeding is uncertain.			x
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of ANH on coagulation parameters is uncertain.		NA	X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of ANH on length of hospital stay is uncertain.			X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of ANH on length of ICU stay is uncertain.			X

ANH, acute normovolemic haemodilution; ICU, intensive care unit

(See Table 2.2)

RECOMMENDATION – acute normovolemic haemodilution

R14 Grade C	In adult patients undergoing surgery in which substantial blood loss (blood loss of a volume great enough to induce anaemia that would require therapy) is anticipated, the use of ANH should be considered (Grade C).

PRACTICE POINT – acute normovolemic haemodilution

PP12	ANH requires a local procedural guideline that addresses patient selection, vascular access, volume of blood withdrawn, choice of replacement fluid, blood storage and handling, and timing of reinfusion.

ANH, acute normovolemic haemodilution