Winthrop-University Hospital neurosurgeon, Nancy E. Epstein, MD, one of the few in this region with expertise and experience in these techniques, employs them when performing lumbar spine surgery on patients who meet strict criteria.

Working closely with Winthrop anesthesiologists, she utilizes normovolemic hemodilution. The strategy entails drawing one or more units of the patient's blood just prior to the first surgical incision and immediately replacing it with three-to-four times the volume (normovolemic) of sterile intravenous fluid. This helps maintain optimal blood pressure during the surgery and simultaneously dilutes the blood (hemodilution) so that when the patient bleeds during the operation, fewer red blood cells are lost.

Remaining in continuity with the patient's body through an intravenous line, the removed, concentrated blood is stored at the patient's side, and is returned to the body at the end of the surgery or sooner, if necessary.

Recommended for use by the National Heart, Lung and Blood Institutes, bloodless surgery is an approach whose time has come. "In about 80 percent of cases, these patients don't need blood transfusions," said Dr. Epstein. "And they receive the blood that's best for them -- their own. Most important, they can avoid preoperative anemia, which can occur when a patient donates blood prior to surgery."

Dr. Epstein has successfully used normovolemic hemodilution at Winthrop with more than 75 patients. One of them, Bonnie Hendricks, reported that she "felt strong and well going into the operating room." She added: "In the past, when I donated blood before the surgery, I felt fatigued." Another satisfied patient, Patricia Grimm, said, "I was in agonizing pain and immobilized before my surgery. If I had to donate blood, the operation would have been delayed."

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