Perioperative Autologous Blood Conservation Using Acute Normovolemic Hemodilution in a Patient Undergoing Elective Craniotomy for Suspected Meningioma: A Case Report

Abstract

Background:  Acute normovolemic hemodilution (ANH) is a perioperative blood conservation technique in which a predetermined volume of autologous whole blood is collected from the patient shortly before or at the onset of surgery, replaced with crystalloid or colloid solution to maintain normovolemia, and reinfused during or after the period of major surgical blood loss. ANH reduces the net erythrocyte loss during surgery and may reduce or eliminate the need for allogeneic transfusion.

Case Presentation:  A 51-year-old woman with a left frontoparietal extraaxial tumor (suspected en plaque meningioma, 7 × 5 × 3 cm) was scheduled for elective craniotomy via a frontotemporal approach. Preoperative hemoglobin was 14.2 g/dL, hematocrit 42.6%, platelet count 299 × 10³/µL, and the coagulation profile was within normal reference ranges. Hepatic, renal, and cardiopulmonary function were clinically adequate for ANH candidacy. Two units of autologous whole blood (350 mL each; total 700 mL) were collected perioperatively using the ANH technique: the first unit several hours before surgery and the second at the commencement of surgery under anesthesiological supervision. Normovolemia was maintained using replacement fluid. Both units were labeled, stored at room temperature in the operating theater, and reinfused in reverse order (most recently collected unit first) during and at the conclusion of the procedure. Intraoperative blood loss was approximately 600 mL. No allogeneic transfusion was required. Postoperative hemoglobin was 11.8 g/dL, representing mild, clinically acceptable anemia. No transfusion reaction was observed. The patient demonstrated clinical improvement and was discharged for outpatient follow-up.

Conclusion:  This case illustrates that ANH may be a feasible and effective component of perioperative patient blood management in selected elective neurosurgical patients, provided appropriate eligibility assessment, hemodynamic monitoring, standardized labeling, and multidisciplinary coordination are maintained.