AVOIDING ALLOGENEIC TRANSFUSION DESPITE E XTREME BLOOD-LOSS

We report the case of a 22-year-old woman who underwent two-step scoli osis surgery without allogeneic transfusion, although the intraoperati ve blood loss (3500 mi) during the first procedure was higher than the calculated blood volume (3250 mi). Preoperatively the patient had don ated four units of autologous blood. Intraoperatively blood-saving met hods were combined. During the first operation acute normovolemic hemo dilution (target hemoglobin 9.0 g/dl) was applied and during the secon d operation controlled hypotension (systolic blood pressure 80 mmHg). Intraoperative autotransfusion was used in both procedures. During the first operation severe normo-volemic anemia (minimal hemoglobin 3.5 g /dl) was accepted while the patient was ventilated with FiO(2) 1.0. Th e hemoglobin concentration was 8.6 g/dl after the first procedure and had increased to 11.6 g/dl 4 weeks after the second procedure. No seve re complications occurred during the postoperative phase. This case re port shows that also in surgical procedures with extreme blood loss an y allogeneic transfusion can be avoided by the combination of blood-sa ving methods,acceptance of low intraoperative transfusion trigger and ventilation with 100% oxygen.