Acute Normovolemic Hemodilution in a Patient with Severe Peripheral Arterial Disease: A Rare Case Report

Liu Zhang; Xuejie Li

doi:doi:10.11648/j.ijacm.20231101.22

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Acute Normovolemic Hemodilution in a Patient with Severe Peripheral Arterial Disease: A Rare Case Report

Liu Zhang, Xuejie Li

Published in International Journal of Anesthesia and Clinical Medicine (Volume 11, Issue 1)

Received: 17 May 2023 Accepted: 6 June 2023 Published: 21 June 2023

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Abstract

Acute normovolemic hemodilution (ANH) is a blood conservation technique that involves withdrawing blood from a patient before surgery and replacing it with a combination of crystalloid and/or colloid solutions, prior to any surgical bleeding. The withdrawn blood can be re-infused during or after the surgical procedure to reduce the need for allogeneic blood transfusions. Patients with high levels of hemoglobin (Hb) and hematocrit (Hct) are at an increased risk of thromboembolic events due to the higher whole blood viscosity (WBV). By reducing blood cell concentration and blood viscosity, ANH can decrease the thromboembolic events during and after surgery in patients with elevated Hb and Hct levels. This article specifically describes the application of ANH in a patient with critical limb ischemia who underwent lower limb thrombectomy and presented with high Hb and Hct levels. ANH presents a promising new approach to reducing the need for allogeneic blood transfusion, while also potentially decreasing the rate of thromboembolic events perioperatively. However, further research is needed to determine the optimal target Hct for patients with polycythemia undergoing ANH, which will help to establish a goal directed ANH. Additionally, the safety and efficacy of ANH should be evaluated in larger populations to ensure its effectiveness and safety. Despite these limitations, ANH remains a compelling and exciting new approach to minimizing the risk of thromboembolic events during and after surgery, and may represent an important tool for improving patient outcomes in the future.

Published in	International Journal of Anesthesia and Clinical Medicine (Volume 11, Issue 1)
DOI	10.11648/j.ijacm.20231101.22
Page(s)	58-61
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Acute Normovolemic Hemodilution (ANH), Peripheral Arterial Disease (PAD), Critical Limb Ischemia (CLI)

References

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[2]	Lawson NW, Ochsner JL, Mills NL, Leonard GL. The Use of Hemodilution and Fresh Autologous Blood in Open-Heart Surgery: Anesthesia & Analgesia 1974; 53: 672???682. https://doi.org/10/br93qc.
[3]	Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 69: e71–126. https://doi.org/10/gfh4k8.
[4]	Criqui MH, Matsushita K, Aboyans V, Hess CN, Hicks CW, Kwan TW, et al. Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions: A Scientific Statement From the American Heart Association. Circulation 2021; 144. https://doi.org/10/gn45dt.
[5]	Song P, Fang Z, Wang H, Cai Y, Rahimi K, Zhu Y, et al. Global and regional prevalence, burden, and risk factors for carotid atherosclerosis: a systematic review, meta-analysis, and modelling study. Lancet Glob Health 2020; 8: e721–9. https://doi.org/10/ggtjpb.
[6]	Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, et al. Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur J Vasc Endovasc Surg 2019; 58: S1-S109. e33. https://doi.org/10/gjfjxf.
[7]	Armstrong EJ, Armstrong DG. Vascular Disease Patient Information Page: Critical limb ischemia. Vasc Med 2021; 26: 228–31. https://doi.org/10/gr7jzk.
[8]	Abu Dabrh A M, Steffen MW, Undavalli C, Asi N, Wang Z, Elamin MB, et al. The natural history of untreated severe or critical limb ischemia. J Vasc Surg 2015; 62: 1642-1651. e3. https://doi.org/10/f72cbm.
[9]	Caputi CA, De Carolis G. Peripheral vascular disease: flow studies and clinical results after isovolemic hemodilution--case reports. Angiology 1986; 37: 124–7. https://doi.org/10/d3m8pf.
[10]	Triebe G, Münnich U, Liebold F. [A therapeutic comparison between hemodilution and pentoxifylline in arterial obstructive disease. An objective assessment by quantitative Doppler sonography]. Dtsch Med Wochenschr 1992; 117: 523–30. https://doi.org/10.1055/s-2008-1062342.
[11]	Koscielny J, Latza R, Pruss A, Kiesewetter H, Jung F, Meier C, et al. Hypervolumetric hemodilution with HES 100/0.5 10%in patients with peripheral arterial occlusive disease (Fontaine, stage II): an open clinical and pharmacological phase IV study. Clin Hemorheol Microcirc 2000; 22: 53–65.
[12]	Ernst E, Kollar L, Matrai A. [Hemodilution in peripheral arterial occlusive disease. Placebo controlled randomized double-blind study with hydroxyethyl starch or dextran]. Acta Med Austriaca 1991; 18 Suppl 1: 27–9.
[13]	Kim D, Cho DJ, Cho YI. Reduced amputation rate with isovolemic hemodilution in critical limb ischemia patients. Clin Hemorheol Microcirc 2017; 67: 197–208. https://doi.org/10/gr6nrf.
[14]	León-Velarde F, Maggiorini M, Reeves JT, Aldashev A, Asmus I, Bernardi L, et al. Consensus statement on chronic and subacute high altitude diseases. High Alt Med Biol 2005; 6: 147–57. https://doi.org/10/cq3h2z.
[15]	Salazar Vázquez BY, Martini J, Chávez Negrete A, Tsai AG, Forconi S, Cabrales P, et al. Cardiovascular benefits in moderate increases of blood and plasma viscosity surpass those associated with lowering viscosity: Experimental and clinical evidence. Clin Hemorheol Microcirc 2010; 44: 75–85. https://doi.org/10/gr7b5q.
[16]	Claydon VE, Norcliffe LJ, Moore JP, Rivera M, Leon-Velarde F, Appenzeller O, et al. Cardiovascular responses to orthostatic stress in healthy altitude dwellers, and altitude residentswith chronic mountain sickness: Effects of altitude on cardiovascular responses to orthostatic stress. Experimental Physiology 2005; 90: 103–10. https://doi:rg/10/b82qd7.

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APA Style

Liu Zhang, Xuejie Li. (2023). Acute Normovolemic Hemodilution in a Patient with Severe Peripheral Arterial Disease: A Rare Case Report. International Journal of Anesthesia and Clinical Medicine, 11(1), 58-61. https://doi.org/10.11648/j.ijacm.20231101.22

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ACS Style

Liu Zhang; Xuejie Li. Acute Normovolemic Hemodilution in a Patient with Severe Peripheral Arterial Disease: A Rare Case Report. Int. J. Anesth. Clin. Med. 2023, 11(1), 58-61. doi: 10.11648/j.ijacm.20231101.22

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AMA Style

Liu Zhang, Xuejie Li. Acute Normovolemic Hemodilution in a Patient with Severe Peripheral Arterial Disease: A Rare Case Report. Int J Anesth Clin Med. 2023;11(1):58-61. doi: 10.11648/j.ijacm.20231101.22

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@article{10.11648/j.ijacm.20231101.22,
  author = {Liu Zhang and Xuejie Li},
  title = {Acute Normovolemic Hemodilution in a Patient with Severe Peripheral Arterial Disease: A Rare Case Report},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {11},
  number = {1},
  pages = {58-61},
  doi = {10.11648/j.ijacm.20231101.22},
  url = {https://doi.org/10.11648/j.ijacm.20231101.22},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20231101.22},
  abstract = {Acute normovolemic hemodilution (ANH) is a blood conservation technique that involves withdrawing blood from a patient before surgery and replacing it with a combination of crystalloid and/or colloid solutions, prior to any surgical bleeding. The withdrawn blood can be re-infused during or after the surgical procedure to reduce the need for allogeneic blood transfusions. Patients with high levels of hemoglobin (Hb) and hematocrit (Hct) are at an increased risk of thromboembolic events due to the higher whole blood viscosity (WBV). By reducing blood cell concentration and blood viscosity, ANH can decrease the thromboembolic events during and after surgery in patients with elevated Hb and Hct levels. This article specifically describes the application of ANH in a patient with critical limb ischemia who underwent lower limb thrombectomy and presented with high Hb and Hct levels. ANH presents a promising new approach to reducing the need for allogeneic blood transfusion, while also potentially decreasing the rate of thromboembolic events perioperatively. However, further research is needed to determine the optimal target Hct for patients with polycythemia undergoing ANH, which will help to establish a goal directed ANH. Additionally, the safety and efficacy of ANH should be evaluated in larger populations to ensure its effectiveness and safety. Despite these limitations, ANH remains a compelling and exciting new approach to minimizing the risk of thromboembolic events during and after surgery, and may represent an important tool for improving patient outcomes in the future.},
 year = {2023}
}

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TY  - JOUR
T1  - Acute Normovolemic Hemodilution in a Patient with Severe Peripheral Arterial Disease: A Rare Case Report
AU  - Liu Zhang
AU  - Xuejie Li
Y1  - 2023/06/21
PY  - 2023
N1  - https://doi.org/10.11648/j.ijacm.20231101.22
DO  - 10.11648/j.ijacm.20231101.22
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 58
EP  - 61
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20231101.22
AB  - Acute normovolemic hemodilution (ANH) is a blood conservation technique that involves withdrawing blood from a patient before surgery and replacing it with a combination of crystalloid and/or colloid solutions, prior to any surgical bleeding. The withdrawn blood can be re-infused during or after the surgical procedure to reduce the need for allogeneic blood transfusions. Patients with high levels of hemoglobin (Hb) and hematocrit (Hct) are at an increased risk of thromboembolic events due to the higher whole blood viscosity (WBV). By reducing blood cell concentration and blood viscosity, ANH can decrease the thromboembolic events during and after surgery in patients with elevated Hb and Hct levels. This article specifically describes the application of ANH in a patient with critical limb ischemia who underwent lower limb thrombectomy and presented with high Hb and Hct levels. ANH presents a promising new approach to reducing the need for allogeneic blood transfusion, while also potentially decreasing the rate of thromboembolic events perioperatively. However, further research is needed to determine the optimal target Hct for patients with polycythemia undergoing ANH, which will help to establish a goal directed ANH. Additionally, the safety and efficacy of ANH should be evaluated in larger populations to ensure its effectiveness and safety. Despite these limitations, ANH remains a compelling and exciting new approach to minimizing the risk of thromboembolic events during and after surgery, and may represent an important tool for improving patient outcomes in the future.
VL  - 11
IS  - 1
ER  -

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Author Information

Liu Zhang

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
Xuejie Li

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China

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Plain Text BibTeX RIS

APA Style

Liu Zhang, Xuejie Li. (2023). Acute Normovolemic Hemodilution in a Patient with Severe Peripheral Arterial Disease: A Rare Case Report. International Journal of Anesthesia and Clinical Medicine, 11(1), 58-61. https://doi.org/10.11648/j.ijacm.20231101.22

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ACS Style

Liu Zhang; Xuejie Li. Acute Normovolemic Hemodilution in a Patient with Severe Peripheral Arterial Disease: A Rare Case Report. Int. J. Anesth. Clin. Med. 2023, 11(1), 58-61. doi: 10.11648/j.ijacm.20231101.22

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AMA Style

Liu Zhang, Xuejie Li. Acute Normovolemic Hemodilution in a Patient with Severe Peripheral Arterial Disease: A Rare Case Report. Int J Anesth Clin Med. 2023;11(1):58-61. doi: 10.11648/j.ijacm.20231101.22

Copy | Download

@article{10.11648/j.ijacm.20231101.22,
  author = {Liu Zhang and Xuejie Li},
  title = {Acute Normovolemic Hemodilution in a Patient with Severe Peripheral Arterial Disease: A Rare Case Report},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {11},
  number = {1},
  pages = {58-61},
  doi = {10.11648/j.ijacm.20231101.22},
  url = {https://doi.org/10.11648/j.ijacm.20231101.22},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20231101.22},
  abstract = {Acute normovolemic hemodilution (ANH) is a blood conservation technique that involves withdrawing blood from a patient before surgery and replacing it with a combination of crystalloid and/or colloid solutions, prior to any surgical bleeding. The withdrawn blood can be re-infused during or after the surgical procedure to reduce the need for allogeneic blood transfusions. Patients with high levels of hemoglobin (Hb) and hematocrit (Hct) are at an increased risk of thromboembolic events due to the higher whole blood viscosity (WBV). By reducing blood cell concentration and blood viscosity, ANH can decrease the thromboembolic events during and after surgery in patients with elevated Hb and Hct levels. This article specifically describes the application of ANH in a patient with critical limb ischemia who underwent lower limb thrombectomy and presented with high Hb and Hct levels. ANH presents a promising new approach to reducing the need for allogeneic blood transfusion, while also potentially decreasing the rate of thromboembolic events perioperatively. However, further research is needed to determine the optimal target Hct for patients with polycythemia undergoing ANH, which will help to establish a goal directed ANH. Additionally, the safety and efficacy of ANH should be evaluated in larger populations to ensure its effectiveness and safety. Despite these limitations, ANH remains a compelling and exciting new approach to minimizing the risk of thromboembolic events during and after surgery, and may represent an important tool for improving patient outcomes in the future.},
 year = {2023}
}

Copy | Download

TY  - JOUR
T1  - Acute Normovolemic Hemodilution in a Patient with Severe Peripheral Arterial Disease: A Rare Case Report
AU  - Liu Zhang
AU  - Xuejie Li
Y1  - 2023/06/21
PY  - 2023
N1  - https://doi.org/10.11648/j.ijacm.20231101.22
DO  - 10.11648/j.ijacm.20231101.22
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 58
EP  - 61
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20231101.22
AB  - Acute normovolemic hemodilution (ANH) is a blood conservation technique that involves withdrawing blood from a patient before surgery and replacing it with a combination of crystalloid and/or colloid solutions, prior to any surgical bleeding. The withdrawn blood can be re-infused during or after the surgical procedure to reduce the need for allogeneic blood transfusions. Patients with high levels of hemoglobin (Hb) and hematocrit (Hct) are at an increased risk of thromboembolic events due to the higher whole blood viscosity (WBV). By reducing blood cell concentration and blood viscosity, ANH can decrease the thromboembolic events during and after surgery in patients with elevated Hb and Hct levels. This article specifically describes the application of ANH in a patient with critical limb ischemia who underwent lower limb thrombectomy and presented with high Hb and Hct levels. ANH presents a promising new approach to reducing the need for allogeneic blood transfusion, while also potentially decreasing the rate of thromboembolic events perioperatively. However, further research is needed to determine the optimal target Hct for patients with polycythemia undergoing ANH, which will help to establish a goal directed ANH. Additionally, the safety and efficacy of ANH should be evaluated in larger populations to ensure its effectiveness and safety. Despite these limitations, ANH remains a compelling and exciting new approach to minimizing the risk of thromboembolic events during and after surgery, and may represent an important tool for improving patient outcomes in the future.
VL  - 11
IS  - 1
ER  -

Copy | Download