The effect of fluid administration on the hemoglobin concentration Fluid administration may result in a beneficial increase in microvascular flow (and perfusion pressure) with a global increase in oxygen delivery (DO2) and cellular oxygenation in conditions of relative volume deficit (e.g., distributive shock in sepsis). In patients in septic shock who received large amounts of fluids as part of the original early GDT protocol, a decrease of 30% in hematocrit was uniformly observed 3 h into the resuscitation, possibly explaining the very high incidence of blood transfusions in this group of patients [9]. In another prospective study comparing patients before and after the adoption of a GDT protocol, a pulse pressure variation-guided protocol was associated with less fluid administration, significantly higher Hb values after surgery, less blood transfusions, and decreased morbidity [14]. Panel a reproduced with permission from Hospital Healthcare Europe (http://www.hospitalhealthcare.com/theatres/haemodilution-and-avoidable-blood-transfusions) Continuous non-invasive monitoring of hemoglobin (“SpHb”) may detect the development of iatrogenic hemodilution Although questions have been raised regarding the absolute accuracy of continuous non-invasive measurement of Hb concentration (SpHb) [15], this parameter may be a useful trend monitor in the management of severe perioperative bleed...

Iatrogenic hemodilution: a possible cause for avoidable blood transfusions?

10.1186/s13054-017-1872-1