Acute Normovolemic Hemodilution May Not Reduce Transfusion Needs in Women Undergoing Cardiac Surgery: Study

A new study published in the Journal of American Medical Association showed that there was no connection found between acute normovolemic hemodilution (ANH) and a decrease in the need for allogeneic packed red blood cell (pRBC) transfusions in female patients having cardiac surgery.

Despite the ANH trial indicating no notable decrease in the number of patients receiving allogeneic blood transfusions with ANH, there is insufficient data on how effective and safe this method is for female patients. This research assessed the effectiveness and safety of ANH in comparison to standard care for female patients having elective cardiac surgery with cardiopulmonary bypass.

This study involved a retrospective analysis of data from the ANH trial which carried out at 32 locations across 11 countries between April 2019 and December 2024. Out of the 2010 participants in the original trial, 405 were female and were part of this specific analysis. Among them, 219 were assigned to receive ANH treatment while 186 received standard care. The main focus was on the occurrence of at least one allogeneic pRBC transfusion during the initial hospital stay. Safety measures assessed included intraoperative hypotension, length of stay in the intensive care unit (ICU) and the hospital, mortality rates, and other complications related to the perioperative period.

The median age with interquartile range (IQR) of the participants was 62 years (54-69). The incidence of allogeneic pRBC transfusion was comparable between the ANH and standard care groups (38.8% vs 44.6%, respectively; relative risk [RR], 0.87; 95% confidence interval [CI], 0.69-1.10; P = .24). Intraoperative hypotension was more frequent in the ANH group (16.0% vs 4.8% in standard care; RR, 3.30; 95% CI, 1.62-6.74; P = .02).

Patients who underwent ANH had extended stays in the ICU (mean difference, 21.13 hours; 95% CI, 1.89-40.38; P = .03) and the hospital (mean difference, 1.92 days; 95% CI, 0.14-3.70; P = .04). There were no significant variations in mortality rates or other postoperative complications. Overall, ANH did not show a correlation with a decrease in allogeneic pRBC transfusion in female patients undergoing cardiac surgery. However, it was linked to a higher occurrence of intraoperative low blood pressure and extended stays in the ICU and hospital.

Source:

Pruna, A., Scandroglio, A. M., Lei, C., Oriani, A., Di Fazio, A., Pontillo, D., Santonocito, C., Bonizzoni, M. A., Comis, M., Calabrò, M. G., Kadantseva, K., Barucco, G., Guarracino, F., Giardina, G., Ajello, V., Di Prima, A. L., Osinsky, R., Oliva, F. M., Efremov, S., … ANH Study Group. (2026). Safety and efficacy of acute normovolemic hemodilution in female patients: A secondary analysis of the ANH trial: A secondary analysis of the ANH trial. JAMA Surgery. https://doi.org/10.1001/jamasurg.2026.4786