Blood management in total knee arthroplasty: a comparison of techniques

Patients undergoing total knee arthroplasty (TKA) are at high risk for postoperative anemia and allogeneic blood transfusions. Risks associated with allogeneic blood exposure (ie, infection, fluid overload, and longer hospital stays) have prompted alternative blood management strategies. The main goal of this study was to evaluate whether a single change in the clinical blood management of patients undergoing TKA reduced the severity of postoperative anemia or the need for allogeneic blood transfusions. A second goal of this study was to assess the financial impact of the change on the institution. This study compared perioperative cell salvage, preoperative autologous blood donation, and the practice of using allogeneic blood alone in patients undergoing TKA. Clinical and financial data of 154 unique cases of primary TKA at the Mayo Clinic Arizona were retrospectively reviewed. Transfusion rates were 25%, 18%, and 52% respectively for patients in the cell salvage, preoperative autologous blood donation, and allogeneic blood only groups. Respective relative risk reductions were 51.9% (P=.007) and 65.4% (P=.002) with the use of cell salvage or preoperative autologous blood donation versus allogeneic alone. Cell salvage and preoperative autologous blood donation were found to significantly reduce the requirements for allogeneic blood transfusions; these techniques were found to be roughly equivalent in clinical benefit when compared to the use of allogeneic blood alone. The logistical advantages of cell salvage (ie, no preoperative blood donation, no risk of wasting blood units) were associated with greater costs to the institution.

The utility of the perioperative autologous transfusion system OrthoPAT in total hip replacement surgery: a prospective study

BACKGROUND

Total hip replacement (THR) is associated with a significant perioperative blood loss, and 30-50% of these patients receive allogeneic blood transfusion (ABT). We evaluated the clinical utility of washed shed blood (WSB) return to reduce ABT in THR patients.

STUDY DESIGN AND METHODS

Data from 108 consecutive THR patients were prospectively collected. WSB salvage and reinfusion (OrthoPAT) was intended for 60 (Reinfusion group), whereas the remaining 48 patients served as control group. Patients received ABT if haemoglobin <8 g/dl or clinical signs and symptoms of acute anemia.

RESULTS

WSB return was possible in 49 patients (205 +/- 151 ml of erythrocyte/patient), without any clinically relevant incident. Return of WSB decreased both the ABT rate (48 vs. 15%, for control and reinfusion groups, respectively; P = 0.001) and the ABT index (371 +/- 154 ml RBC vs. 53 +/- 117 ml RBC, respectively; P = 0.001), without differences between cemented and uncemented THR. In addition, patients from reinfusion group showed a trend to lower postoperative infection rate (10 vs. 2%, respectively; P = 0.086).

CONCLUSIONS

Perioperative salvage and return of WSB in THR seems to effectively reduce the requirements for ABT. However, for patients with preoperative Hb < 13 g/dl, some additional blood saving method should be associated to WSB return.