[Acute "normovolemic" hemodilution with 3.5% polygel (Haemaccel) for patients in the Wertheim-Meigs-operation. Blood loss of 87% blood volume without perioperative blood transfusion].

QUESTION: Is polygeline (Haemaccel) a suitable colloid to perform preoperative acute normovolemic hemodilution (ANH) and to replace a large intraoperative 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). Intraoperative retransfusion of ANH blood was started at a hematocrit 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 labelling erythrocytes with fluorescein) was determined before and after ANH, before retransfusion, and postoperatively.
RESULTS: After removal of 1,940 ml of blood and replacement with 15% more of colloid, blood volume decreased by 760 ml. After a mean blood loss of 4,600 ml, 290 ml and 260 ml of red cells were saved due to ANH and use of a cell saver, respectively.
CONCLUSIONS: The exact double label measurements of blood volume demonstrated that polygeline, which has a volume effect of only 50%, cannot be considered to be a suitable colloidal substitute during ANH.