Anesth Pain Med.  2020 Apr;15(2):181-186. 10.17085/apm.2020.15.2.181.

Acute normovolemic hemodilution for a patient with secondary polycythemia undergoing aortic valve replacement due to severe aortic stenosis - A case report -

• Han I
• Cho YW
• Park SE
• An MG
• Kang HJ
• Lee Ar

• KMID: 2500969
• DOI: http://doi.org/10.17085/apm.2020.15.2.181

Abstract

Background
A high hematocrit level in patients with erythrocytosis is linked with increased blood viscosity and increased risk of thromboembolism. Therefore, it is necessary to adequately lower the hematocrit level before performing a high-risk surgery. Case: A 67-year-old man was scheduled for aortic valve replacement due to severe aortic stenosis. The preoperative hematocrit level of this patient was very high due to secondary polycythemia by hypoxia. We decided to perform acute normovolemic hemodilution after anesthetic induction to reduce the risk of thromboembolism in the patient. The patient was discharged after a successful surgery and a post-operative period without any side effects.
Conclusions
We estimate that patients with secondary polycythemia may benefit from acute normovolemic hemodilution to reduce their hematocrit levels while undergoing cardiac surgery using cardiopulmonary bypass. However, it is necessary to control the hematocrit level, since a significant decrease can cause side effects.

Keyword

Cardiopulmonary bypass; Erythrocytosis; Hemodilution; Polycythemia; Thromboembolism

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