Figure 2

The concept of augmented acute normovolemic haemodilution (A-ANH)is divided into three periods (a-c). (a) Preoperative ANH with conventionalvolume replacement without the use of an artificial oxygen carrier such as aperfluorocarbon emulsion. Preoperative ANH targets relatively low hemoglobinlevels, close to the individual transfusion trigger. (b) During surgery whenthe haemoglobin concentration is expected to fall further due to surgical bloodloss, a perfluorocarbon emulsion will be used to augment oxygen-offloadingcapacity to the body. Note that total oxygen offloading capacity from combinedhaemoglobin-based and perfluorocarbon emulsion-based oxygen transport ismaintained during surgery at the level reached after preoperative ANH (ie abovethe individual transfusion trigger, despite low haemoglobin concentrationstowards the end of surgery).(c) Postoperative retransfusion (Postop. RT) of ANHblood increases the haemoglobin concentration above the individual transfusiontrigger. Therefore, the decreasing contribution of PFC emulsion-based oxygentransport will not adversely affect overall oxygenation of the organism.