Techniques for hepatectomies without blood transfusion, focusing on interpretation of postoperative anemia

HYPOTHESIS: Transient postoperative anemia is partially a physiologic phenomenon, and variations in blood transfusion rates after liver resection in different series in part are due to different interpretations of postoperative anemia. Based on the hypothesis that transient postoperative anemia is partially a physiologic phenomenon, we analyzed serum hemoglobin and hematocrit values in patients who underwent liver resection without blood transfusion to check fluctuations. DESIGN: Prospective cohort study. SETTING: Community hospital.PATIENTS: Forty-six consecutive patients with primary and metastatic liver tumors. INTERVENTIONS: Surgical treatment consisting of dissection technique performed under intermittent warm ischemia, using intraoperative ultrasonography, and without blood transfusion. MAIN OUTCOME MEASURES:Hematocrit and hemoglobin concentrations in serum sampled preoperatively and on the first, third, fifth, and seventh stoperative days. RESULTS: No postoperative mortality and major morbidity were observed. No patient received a blood transfusion. The hematocrit and hemoglobin concentrations in serum were significantly lower on the third postoperative day than on the first, fifth, and seventh postoperative days; differences among the first, fifth, and seventhpostoperative days were not significant. CONCLUSIONS: The fluctuations of hemoglobin and hematocrit levels after liver resection showed a steady and significant decrease until the third postoperative day and then an increase.Therefore, a decrease in the hemoglobin and hematocrit levels between first and fifth postoperative days without evidence of active bleeding from drain discharge or any other possible source of bleeding does not justify blood administration.