Correspondence  |   June 2003
Acute Normovolemic Hemodilution: The Subgroup of Patients Likely To Benefit Remains Uncertain: In Reply
Author Notes
  • Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Article Information
Correspondence   |   June 2003
Acute Normovolemic Hemodilution: The Subgroup of Patients Likely To Benefit Remains Uncertain: In Reply
Anesthesiology 6 2003, Vol.98, 1519. doi:
Anesthesiology 6 2003, Vol.98, 1519. doi:
In Reply:—
I take this opportunity to thank Drs. Lentschener and Ozier for their comments and showing keen interest in our recent article. 1 It is true that the number of liver resections without transfusion has increased substantially in recent years. However, as reported by Gozzetti et al.  2 and Rees et al.  , 3 despite the improvement in surgical and anesthetic technique, 41% and 38% of liver resections (minor and major) required transfusion, respectively. In addition, only 19.6% of major hepatectomies were performed without intraoperative blood transfusion. 2 Although in the present study we included ASA 1 or 2 patients, the study included only patients scheduled to major hepatic resections. Moreover, a third of the patients had previous surgery, and on four occasions, the vena cava was involved. Therefore, I believe that the 36% transfusion rate found in the present study is not unacceptable. I agree with Lentschener and Ozier that acute normovolemic hemodilution is not expected to lower the need for blood transfusion in all patients undergoing liver resection. However, as suggested in the present study, it may benefit patients undergoing major hepatic resections. It seems that future work in this area should focus on Child B patients, as suggested by Lentschener and Ozier.
Matot I, Scheinin O, Jurim O, Eid A: Effectiveness of acute normovolemic hemodilution to minimize allogeneic blood transfusion in major liver resections. A nesthesiology 2002; 97: 794–800Matot, I Scheinin, O Jurim, O Eid, A
Gozzetti G, Mazziotti A, Grazi GL, Jovine E, Gallucci A, Gruttadauria S, Frena A, Morganti M, Ercolane G, Masetti M, Pierangeli F: Liver resection without blood transfusion. Br J Surg 1995; 82: 1105–10Gozzetti, G Mazziotti, A Grazi, GL Jovine, E Gallucci, A Gruttadauria, S Frena, A Morganti, M Ercolane, G Masetti, M Pierangeli, F
Rees M, Plant G, Wells J, Bygrave S: One hundred and fifty hepatic resections: Evolution of technique towards bloodless surgery. Br J Surg 1996; 83: 1526–9Rees, M Plant, G Wells, J Bygrave, S