Acute Normovolemic Hemodilution: A Critical Evaluation of Its Safety and Utility in Pediatric Patients

Summary The use of blood conservation techniques has gained importance since the 1980s when hazards of blood transfusion, especially transfusion of infectious agents, became well recognized. In adult medicine, predonation autologous blood donation (PABD) and techniques of intraoperative and postoperative collection and reinfusion, initially perfected during the Vietnam era, were used with increased frequency. Methods to limit homologous transfusion in pediatrics were slow to develop, at least in part due to limitations of venous access, operational complexity and the unique and ever changing physiology of the infant and toddler. Blood conservation techniques include PABD, intraoperative hemodilution, intraoperative blood recovery and postoperative scavenging. The history and physiology of hemodilution and its application in pediatric surgery patients with and without additional conservation methods in different clinical conditions will be discussed. In particular, the use of acute normovolemic hemodilution in pediatrics will be the focus of this review.