THE PRICE-2 trial investigated whether hypovolaemic phlebotomy reduces the need for red blood cell transfusions compared to usual care in patients undergoing liver resection. Blood loss and subsequent transfusions are common challenges in liver surgery, often increasing patient risks and healthcare burden. Hypovolaemic phlebotomy involves the removal of 7–10 mL/kg of whole blood before liver transection without volume replacement, aiming to minimise blood loss during surgery. This multicentre, single-blind, randomised controlled trial was conducted across four Canadian tertiary-care hospitals and included patients considered at high risk of significant blood loss during liver resection.
Between October 2018 and January 2023, 486 patients were randomly assigned to receive hypovolaemic phlebotomy or usual care. After excluding those who did not undergo liver resection, 223 patients remained in each group. In the hypovolaemic phlebotomy group, 17 patients (8%) required red blood cell transfusions within 30 days, compared to 36 patients (16%) in the usual care group. This resulted in a significant reduction in transfusion rates, with a difference of –8.8 percentage points and an adjusted risk ratio of 0.47. These findings indicate that patients receiving hypovolaemic phlebotomy were approximately 50% less likely to need a transfusion than those in the usual care group.
The incidence of severe complications within 30 days was similar between the two groups, occurring in 17% of patients receiving hypovolaemic phlebotomy and 16% in the control group. Overall complications were slightly higher in the hypovolaemic phlebotomy group at 61%, compared to 52% in the usual care group, but this difference was not statistically significant. Notably, there were no postoperative deaths within 90 days in either group.
The study’s findings demonstrate that hypovolaemic phlebotomy effectively reduces the need for red blood cell transfusions without significantly increasing complications or mortality. These results suggest that hypovolaemic phlebotomy improves operative conditions and provides a viable approach to managing blood loss in patients undergoing liver resection, particularly those at higher risk of bleeding. Consequently, hypovolaemic phlebotomy should be considered for routine use in liver surgery to optimise patient outcomes and reduce transfusion-related risks.
Katie Wright, EMJ
Reference
Martel G et al. Hypovolaemic phlebotomy in patients undergoing hepatic resection at higher risk of blood loss (PRICE-2): a randomised controlled trial. Lancet Gastroenterol Hepatol. 2024; DOI:10.1016/S2468-1253(24)00307-8.
