Objective To observe the effects of acute normovolemic hemodilution (ANH) on coagulation function and fibrinolysis in elderly patients undergoing hepatic carcinectomy. Methods Thirty elderly patients (aged 60-70 years) with liver cancer (American Society of Anesthesiologists physical status I-II) scheduled for hepatic carcinectomy from February 2007 to February 2008 were randomly divided into ANH group (n=15) and control group (n=15). After tracheal intubation

patients in ANH group and control group were infused with 6% hydroxyethyl starch (HES) (130/0.4)

and basic liquid containing 6% HES and routine Ringer's solution

respectively. In all the studied patients

blood samples were drawn at five different time points: before anesthesia induction (T1)

30 minutes after ANH (T2)

1 hour after start of operation (T3)

immediately after operation (T4)

and 24 hours after operation (T5). Then coagulation function

soluble fibrin monomer complex (SFMC)

prothrombin fragment (F1+2)

and platelet membrane glycoprotein (activated GPIIb/GPIIIa and P-selectin) were measured. Results The perioperative blood loss was not significantly different between the two groups (P>0.05). The volume of allogeneic blood transfusion in ANH group was significantly smaller than that in control group (350.5∓70.7 mL vs. 457.8∓181.3 mL

P<0.01). Compared with the data of T1

prothrombin time (PT) and activated partial thromboplastin time in both groups prolonged significantly after T3 (P<0.05)

but still within normal range. There were no significant changes in thrombin time and D-dimer between the two groups and between different time points in each group (all P>0.05). SFMC and F1+2 increased in both groups

but without statistical significance. P-selectin expression on the platelet surface of ANH group was significantly lowered at T2 and T3 compared with the level at T1 (P<0.05). Compared with control group

P-selectin was sig-nificantly lower in ANH group at T2-T5 (all P<0.05). Conclusions In elderly patients undergoing resection of liver cancer

ANH may not hamper fibrinolysis and coagulation function. It could therefore be safe to largely reduce allogeneic blood transfusion.