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Impact of intraoperative normovolemic hemodilution on transfusion requirements for 68 patients undergoing lumbar laminectomies with instrumented posterolateral fusion.

Epstein NE, Peller A, Korsh J, DeCrosta D, Boutros A, Schmigelski C, Greco J

Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, NY, USA. dch3@columbia.edu

STUDY DESIGN: To determine whether the normovolemic hemodilution (NH) technique would limit postoperative homologous blood transfusion requirements in 68 patients having multilevel lumbar laminectomies (3-6 levels) with predominant 1- or 2-level instrumented fusions. OBJECTIVE: In this setting, to define postoperative homologous blood transfusion requirements using NH. SUMMARY OF BACKGROUND DATA: NH limits postoperative homologous blood transfusion requirements following various types of surgical procedures including those on the spine. METHODS: NH was used in an attempt to limit postoperative homologous transfusion requirements in 68 patients undergoing lumbar surgery. NH involves the removal of 1 to 2 U of blood replaced with crystalloid (2-4 mL per milliliter of blood harvested). Multiple variables contributing to homologous transfusion requirements were analyzed. RESULTS: Using NH, no homologous blood transfusions were required in 52 patients with a mean preoperative hematocrit of 41.3 undergoing average 3.7 level laminectomies with 1.5 level fusions. However, 16 patients with an average preoperative hematocrit of 38.5 undergoing average 4.3 level laminectomies with 1.6 level fusions required transfusion of 31 U of homologous blood after surgery. CONCLUSIONS: Using NH, 16 (23.5%) patients required 31 postoperative homologous blood transfusions. By contrast, the remaining 52 patients with similar procedures were able to avoid the use of homologous transfusion.

Published 1 September 2006 in Spine, 31(19): 2227-30; discussion 2231.
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