A simple method for calculating component dilution during fluid resuscitation: the Leuven approach.

STUDY

OBJECTIVES

To test the reliability of the Leuven approach, a balance between oversimplified empiric rules and more complex calculations requiring the use of nomograms or computers, to determine blood component dilution during large transfusions. To present schemes for blood component dilution and stabilization, as well as four examples showing the practicability of the method.

DESIGN

Prospective study.

SETTING

Orthopedic operating rooms at a university hospital.

PATIENTS: 108 patients undergoing total hip replacement with expected large blood loss.

INTERVENTIONS: Component concentrations were measured after patient arrival in the recovery room. Blood loss was followed clinically.

MEASUREMENTS AND MAIN

RESULTS

Preset target component concentrations [hematocrit (Hct) 31%; total serum protein (TSP) 5.0 g/dl; prothrombin time (PT) 50%; blood platelets (BLPL) 50,000/microliters)] were compared with concentrations measured on arrival in recovery after dilution and stabilization, according to the transfusion scheme. Average blood loss was 3,226 +/- 1,600 ml (mean +/- SD). End component concentrations were Hct, 33.4% +/- 3.3%; TSP, 5.2 +/- 0.5 g/dl; PT, 52% +/- 12%; BLPL, 97,000/microliters. Hct and TSP showed significant (p < 0.05) but clinically unimportant differences from target concentrations. Possible reasons for variability in end concentrations are discussed.

CONCLUSION

The Leuven approach produces reliable blood component concentrations after extensive transfusions. It allows the clinician to decide for himself or herself, in accordance with general consensus and the patient's individual needs, when to stabilize blood components.