[Evaluation effect of acute normovolemic Hemodilution [ANH] on hemostasis in coronary artery bypass surgery [CABG] under cardiopulmonary bypass with thromboelastography [TEG] analyzer]

ABSTRACT

Recognizing that allogenic transfusion is best avoided in all patients, we implemented a policy of transfusion avoidance in coronary artery bypass graft surgery with use of acute normovolemic hemodilution [ANH] technique. ANH is a blood conserving technique and a form of pre-operative autologous donation [PAD].Blood stored at the bedside at room temperature [up to 6 hrs.] ANH technique preserves factors and coagulation of stored blood and also has several advantages in physiologic aspect. Thrombelastogrphy is a noninvaive diagnostic instrument designed to monitor and analyze the coagulation state of a blood sample in order to assist in assessment of patient clinical haemostatic condition. A prospective, randomized, clinical trial conducted in 130 patients scheduled surgery with CPB, that divided to two 65 persons, A [ANH] and B [non-ANH] group. Patients underwent ANH with avg. of 500 ml whole blood removed after induction of anesthesia and hemodilution was replaced with crystalloid solution. Hemoglobin, platelets, TEG analysis and homodynamic changes pre and post operation, amount of blood transfusion during surgery and in ICU checked in both groups. This study shows that amount of Hb, pit, in ANH group was greater than B group. Changes in components of R, K, ANGLE, MA in ANH group were statistically significant, that show greater preservation of coagulation factors, platelets,[actors, platelets, [amount and function] and fibrinogen in ANH group. Changes in homodynamic postoperatively were less in ANH group. performance of ANH in CABG is effective in reduce in blood transfusion and post operation bleeding