Overview :

Blood transfusion may be detrimental to patients with cirrhosis. Wu et al identified patients with cirrhosis who did not require blood transfusion after hepatic resection of a liver tumor. The authors are from Taichung Veterans General Hospital, Chung-Shan Medical Hospital and National Yang-Ming University in Taiwan.

Cirrhotic patients who usually did not require transfusion after resection of a hepatic tumor:

(1) limited blood loss (see below)

(2) tumor < 5 cm in diameter

(3) resection confined to Couinaud's segments II, III, or VI.

where:

• Blood loss estimates during surgery in cirrhotics is often inaccurate.

• Most cirrhotics can tolerate an estimated blood loss of <= 1,600 mL without transfusion. Some can tolerate a blood loss up to 2,350 mL without transfusion. A few may be able to tolerate an even greater blood loss.

• Couinaud divided the liver into 8 lobes. Lobes II and III are the leftmost portions of the left lobe, to the left of the round ligament. Lobe VI is the right lateral inferior segment.

Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surgery Gynecology Obstetrics. 1975; 140: 170-178. (Figure 1, page 171; Couinaud segments).

Couinaud C, Le Foie. Etudes anatomiques et Chirurgicales. Paris. Masson et Cie. 1957.

Wu C-C, Kang S-M, et al. Prediction and limitation of hepatic tumor resection without blood transfusion in cirrhotic patients. Arch Surg 1998; 133: 1007-1010.