Acute normovolemic hemodilution

Question. Is polygeline (Haemaccel (R)) a suitable colloid to perform preop erative acute normovolemic hemodilution (ANH) and to replace a large intrao perative blood loss? Methods. In a sixty-eight-year-old patient undergoing radical hysterectomy preoperative ANH was performed to a hematocrit of 23% using 3.5% polygeline (Haemaccel (R)). Intraoperative retransfusion of ANH blood was started at a hernatocrit of 13%. Plasma volume (indocyanine green-dilution technique) and hematocrit were measured before and after ANH, 3 times intraoperatively (once before retransfusion) and postoperatively. Red cell volume (by label ling erythrocytes with fluorescein) was determined before and after ANH, be fore retransfusion, and postoperatively. Results. After removal of 1,940 ml of blood and replacement with 15% more o f colloid, blood volume decreased by 760 ml. After a mean blood loss of 4,6 00 ml, 290 ml and 260 ml of red cells were saved due to ANH and use of a ce ll saver, respectively. Conclusions. The exact double label measurements of blood volume demonstrated that polygeline, which has a volume effect of on ly 50%, cannot be considered to be a suitable colloidal substitute during A NH.