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2007 Program and Abstracts | 2007 Posters
Reduced Transfusion Requirement During Pancreatic Resection with Use of Intraoperative Isovolemic Hemodilution
Craig P. Fischer*1,2, Wade R. Rosenberg1, Margaret S. Tierney1, Alejandro L. Rosas1, Barbara L. Bass1,2
1The Methodist Hospital, Houston, TX; 2The Department of Surgery, Weill Medical College of Cornell University, New York, NY

Introduction. Isovolemic hemodilution (IVHD) is a technique that may limit blood loss during major operations. Blood transfusion during surgery for malignancy has been shown to be associated with increased tumor recurrence and decreased survival in some series. We hypothesized that the use of IVHD during pancreatic resection would decrease the need for blood transfusion.Methods.27 consecutive patients underwent IVHD, with removal of 600-900 cc of autologous blood at the beginning of the operation. An equal volume of colloid was infused at the time of blood removal. Autologous blood was reinfused at the end of the resection portion of the operation. Patients were transfused with allogeneic packed erythrocytes (PRBC’s) with a transfusion threshold of hematocrit < 30% in both groups. Endpoints examined are shown in the table. Comparisons were made to control patients operated upon by the same surgeon, in the previous calendar year. These patients were case-matched for age, co-morbid conditions and operation performed.Results.No statistical differences were noted in demographics or operations performed between patients who underwent isovolemic hemodiluation (IVHD) and controls. Mean duration of operation, EBL, total i.v. fluids infused were similar between the two groups. Transfusion of allogeneic blood was more common in control patients, than those who underwent IVHD (0.44 ± 0 .20 units v.s 1.33 ± 0.32 units, P < 0.05).Conclusion.The use of IVHD resulted in a statistically significant reduction in PRBC transfusions when compared to control patients undergoing similar pancreatic resections.
Isovolemic Hemodilution v.s. Controls

IVHD n = 27 Control n = 27 P Value
Age61.78 ± 2.8968.15 ±2.04 ns
Weight (kg)70.44± 4.0369.34 ± 5.14 ns
OPERATION PERFORMED
Whipple 14 17
Distal pancreatectomy with en block splenectomy 7 4
Distal pancreatectomy with spleen preservation 6 5
Total pancreatectomy 0 1
Duration of Operation346.88 ± 23.37 359.63 ± 22.97 ns
Estimated Blood Loss (EBL) 832.41 ± 86.581168 ± 104.57 ns
TOTAL I.V. FLUIDS (cc)
Crystaloid5585.12 ± 449.81 5153 ± 473.43 ns
Colloid938.88 ± 81.36 929.63 ± 80.52 ns
Mean Units PRBC's Transfused0.44 ± 0 .201.33 ± 0.32 P < 0.05
Patients Transfused (%) 22.2 % 45.2 %

IVHD - isovolemic hemodilution, EBL -estimated blood loss, figues presented as +/- standard error of the mean (SEM), ns - not statistically significant.


2007 Program and Abstracts | 2007 Posters
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