Restrictive versus liberal blood transfusion policy for hepatectomies in cirrhotic patients

• Published in: World journal of surgery 1989-09, Vol.13 (5), p.644-648
• Main Authors: Makuuchi, Masatoshi, Takayama, Tadatoshi, Gunvén, Peter, Kosuge, Tomoo, Yamazaki, Susumu, Hasegawa, Hiroshi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Blood Transfusion - methods; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - surgery; Cirrhotic Patient; Female; Frais; Gastroenterology. Liver. Pancreas. Abdomen; Hepatectomy - mortality; Humans; Lactic Dehydrogenase Activity; Liver Cirrhosis - mortality; Liver Cirrhosis - surgery; Liver Neoplasms - mortality; Liver Neoplasms - surgery; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Postoperative Care; Postoperative Time Interval; Serum Total Bilirubin; Time Factors; Tumors
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/BF01658893

To evaluate the worth of intra‐ and postoperative blood transfusion in cirrhotic patients undergoing resection for hepatocellular carcinoma, we compared 13 patients receiving transfusions and 14 matched contemporary patients who did not receive blood. Preoperative hematological and biochemical parameters, the type and extent of liver resection, and the mean blood loss (862 and 870 ml) were similar in the 2 groups. The total volume of intra‐ and postoperative blood transfused ranged from 400 to 1,800 ml (mean, 1,223 ml) in the patients receiving transfusions. During various postoperative time intervals, the mean values of hematocrit, hemoglobin, serum total bilirubin, and lactic dehydrogenase activity were significantly higher in the patients who were transfused compared to those who were not. Mean serum transaminase activities were similar in the 2 groups at the same times. The mean hematocrit values decreased from 36.8% preoperatively to a postoperative minimum of 27.0% in the transfused group, and from 39.9% to 26.1% in the nontransfused group. Our experience and theoretical reasons have led us to withhold blood transfusion until the hematocrit values fall below 30% during hepatectomy and below 20% in the postoperative period (or unless circulatory instability cannot be corrected otherwise). Fresh frozen plasma is preferred for volume substitution and, if blood has to be given, only up to 60–70% of estimated losses should be replaced by fresh blood. Résumé Pour évaluer l'importance sur le pronostic des transfusions sanguines per et postopératoires chez le cirrhotique ayant subi une résection hépatique pour cancer hépatocellulaire, nous avons comparé les résultats chez 13 patients transfusés avec ceux de 14 patients non transfusés. Les 2 groupes de patients étaient comparables en ce qui concerne les paramètres hématologiques et biochimiques préopératoires, les types et l'étendue des résections, et la perte sanguine moyenne (862 et 870 ml). Le volume total des transfusions sanguines per‐ et postopératoires variait entre 400 et 1,800 ml (moyenne, 1,223 ml). Pendant la période postopératoire, les valeurs moyennes de l'hématocrite, de l'hémoglobine, de la bilirubine totale, et des lactodéshydrogénases étaient significativement plus hautes chez les patients ayant reçu une transfusion. Le taux moyen des transaminases était similaire dans les 2 groupes. L'hématocrite moyen a chuté de 36.8% en préopératoire à 27.0% en postopératoire chez les patients transfusés,