About 15% to 20% of patients undergoing liver resections require RBC transfusions. Current guidelines propose a number of options to minimize blood loss and transfusion support, but all are based on little or weak evidence. Many options, including hypovolemic phlebotomy, aim to minimize intravenous fluid during liver surgery to maintain hypovolemia. Hypovolemic phlebotomy consists of removing about 10% of a patient’s blood (7-10 mL/kg, approximately one unit for a 70 kg patient) before surgery without replacement of intravenous fluid. The blood is then transfused back into the patient after surgery. The PRICE-2 randomized controlled trial compared hypovolemic phlebotomy to standard of care for adult patients requiring liver resection at a high risk of operative blood loss. In brief, 486 patients were randomized 1:1 at four Canadian academic hospitals. Of the 446 patients who had surgery, 223 (mean age, 61 years; 61% male) received hypovolemic phlebotomy before surgery in addition to standard care while 223 (mean age, 62 years; 51% male) received standard care. Thirty days after surgery, only 8% (17/223) of patients in the hypovolemic phlebotomy arm received RBC transfusions compared to 16% (36/223) in the standard care arm (risk difference, -8.8%; 95% C.I., -14.8 to -2.8). In addition, the median estimated blood loss was less for patients who received hypovolemic phlebotomy than those in the standard arm (679 mL compared to 800 mL, respectively), and morbidity and severe complications were similar. More data, however, are needed for higher-risk patients and to confirm these results.
Reference:
