Medical Services: Centers Of Excellence

The Institute for Patient Blood Management and Bloodless Medicine and Surgery at Englewood Hospital

Techniques: About Albumin, Blood Salvage, About Erythropoietin, About Hemoglobin-Based Oxygen Carriers (HBOCs), About Normovolemic Hemodilution

About Normovolemic Hemodilution

While this term may sound intimidating, when broken down it is easy to understand. Normovolemic (normal volume) Hemodilution (blood dilution) is a process that significantly reduces the amount of blood cells lost during surgery. This is how it works: before surgery ever starts, the surgeon, the anesthesiologist, and other personnel discuss and carefully plan the surgery and blood management. Just before the surgeon begins, an anesthesiologist starts an IV in a vein in the arm. Blood is slowly drained inside a closed system. This blood volume is simultaneously replaced with fluid (a combination of water and minerals), so that the amount of liquid in the blood vessels remains constant. This consistency in volume maintains the patient’s vital sign stability. While this process is going on, surgery starts.

Inevitably, some blood is lost in the process of surgery. However, since this blood has been diluted, the blood is “thin” or has fewer cells and more liquid (red cells are what physicians normally transfuse the most). In turn, the anesthesiologist returns the blood that was removed and has the ability to give back to the patient fresh, whole, cell-rich blood. There is no chance of clerical error as the blood is never stored, and never leaves a closed system which is in constant contact with the patient’s own circulatory system.

Some individuals who refuse transfusions for religious or personal reasons find hemodilution acceptable, since they view it as an extension of their own circulatory system.

Here at Englewood Hospital and Medical Center, the use of hemodilution is not limited to use for patients with religious or personal objections to blood transfusion. Since we have found it to be safe and effective in eliminating the need for traditional blood transfusion, it is used routinely in all patients with a high-anticipated blood loss in surgery. As a result, surgical blood transfusions have been virtually eliminated in our operating rooms, and are, of course, never given to patients who refuse them.

This process once again emphasizes the fact that a successful, safe bloodless medicine and surgery program requires experience, teamwork, and excellent communication.