COMBINATION OF ACUTE NORMOVOLEMIC HAEMODILUTION AND DELIBERATE HYPOTENSION IN ORDER TO AVOID ALLOGENEIC BLOOD TRANSFUSION IN THE MANAGEMENT OF LARGE BLOOD LOSS IN SPINAL TRAUMA SURGERY. CASE REPORT

We report the case of a 35–year-old patient with a displaced fracture of the fourth lumbar vertebra in whom normovolemic haemodilution and deliberate hypotension were used as techniques for avoiding allogeneic blood transfusion during spinal surgery. After starting general anaesthesia, 2000 g of the whole blood was removed and circulation was restored with 1500 ml of colloids and 2000 ml of crystalloids. Retransfusion was started when the blood loss reached 900 ml (transfusion trigger, haematocrit value of 0.25). In the course of anaesthesia, deliberate hypotension (systolic blood pressure, 90 mmHg) was induced and maintained for three hours by continuous application of nitroprusside sodium. The total blood loss was 3500 ml during the 8-hour operation and additional 880 ml postoperatively in 48 h. During the operation we administered a total of 2000 ml of colloids, 6000 ml of crystalloids and 2000 g of blood obtained from acute normovolemic haemodilution. The patient was haemodynamically stable for the whole time, with a final haematocrit value of 0.32. We did not have to use allogeneic blood transfusion.