Reduced transfusion rates at radical hysterectomy with preoperative isovolemic hemodilution and perioperative measurement of erythrocyte volume and plasma volume

Objective: Patients undergoing radical hysterectomy for cancer of the cervi x frequently require intraoperative blood transfusion. The goals of the pre sent study were to measure erythrocyte volume and plasma Volume before and after radical hysterectomy and to reduce the transfusion rate with aggressi ve preoperative normovolemic hemodilution. Methods: Erythrocyte volume and plasma volume were measured simultaneously with nonradioactive markers preoperatively before hemodilution and postoper atively after retransfusion. Preoperative red cell volume and hematocrit we re measured on the day before and immediately after surgery. The calculated blood loss was compared with the estimated blood loss. Results: Preoperatively the erythrocyte Volume (mean +/- SD) was significan tly lower than normal (727 +/- 83 vs. 848 +/- 56 mL/m(2); P < 0.05) whereas the hematocrit was normal (38.5 +/- 3.7%). The preoperative plasma Volume (1650 +/- 242 mL/m(2)) was 118% and blood volume 106% of normal. The calcul ated intraoperative blood loss (1566 +/- 792 mL) was significantly underest imated by an average of 363 +/- 480 mL (P<0.05). Preoperative hemodilution to a hematocrit of 22% and retransfusion at a hematocrit of 15% led to a tr ansfusion rate of 8.6%. Postoperatively the erythrocyte Volume was decrease d to 544 +/- 114 mL/m(2) whereas plasma Volume and blood volume increased ( 1965 +/- 281 and 2495 +/- 353 mL/m(2), respectively). Conclusion: Preoperative normovolemic hemodilution can keep transfusion rat es at radical hysterectomy low despite a low preoperative erythrocyte volum e.