Collection of autologous blood before elective hip replacement. A comparison of the results with the collection of two and four units

Bipolar sealer not superior to standard electrocautery in primary total hip arthroplasty: a meta-analysis

Introduction

To assess whether bipolar sealer has advantages over standard electrocautery in primary total hip arthroplasty (THA).

Methods

All studies published through November 2013 were systematically searched in PubMed, Embase, ScienceDirect, The Cochrane Library, and other databases. Relevant journals or conference proceedings were searched manually. Only randomized controlled trials were included. Two independent reviewers identified and assessed the literature. Mean difference in blood loss and risk ratios of transfusion rates and of complication rates in the bipolar sealer group versus the standard electrocautery group were calculated. The meta-analysis was conducted using RevMan 5.1 software.

Results

Five studies were included, with a total sample size of 559 patients. The use of bipolar sealer did not significantly reduce intraoperative blood loss, hemoglobin drop, hospital stay, and operative time. There were no significant differences in need for transfusion and the incidence of infection between the study groups.

Conclusion

The available evidence suggests that the use of bipolar sealer was not superior to standard electrocautery in patients undergoing primary THA. The use of bipolar sealer is not recommended in primary THA.

Efficacy of preoperative autologous blood donation for elective posterior lumbar spinal surgery

STUDY DESIGN

Retrospective review.

OBJECTIVE

Evaluate the transfusion patterns associated with preoperative autologous blood donation (PABD) during posterior lumbar spinal surgery.

SUMMARY OF BACKGROUND DATA

There is a paucity of evidence in the literature examining the utility of PABD in elective adult lumbar spinal surgery.

METHODS

Medical records of 541 patients treated for spinal stenosis between January 1997 and February 2000 were reviewed. Patients were divided into donors (PABD; n = 413) and nondonors (non PABD [NPABD]; n = 128).

RESULTS

Average preoperative hemoglobin (Hb) in the NPABD group was 0.62 units more than in the PABD group (95% confidence interval [CI] = 0.30-0.94). For PABD patients, there was a negative correlation (-0.3) between preoperative Hb and number of units donated. PABD patients who donated 1 and 2 units of blood were, respectively, 7.5 and 9 times more likely to be transfused within the first 24 hours than NPABD patients. NPABD patients were 25 times more likely to need a transfusion of allogeneic blood than PABD patients who donated at least 2 units of blood. Autologous donation was an independent predictor of perioperative blood loss (P < 0.05). Patients who donated at least 2 units of blood lost approximately 1.3 units of Hb more than NPABD patients. The odds of wastage for a PABD patient who had a decompression with noninstrumented fusion were 8.64 times that of a PABD patient who had a decompression with instrumented fusion.

CONCLUSION

Autologous blood donation induced preoperative anemia and resulted in a lower transfusion threshold than allogeneic blood usage. In addition, we found that autologous donation significantly increased blood loss in the preoperative period as measured by Hb lost. Usage of autologous blood was significantly more efficient in patients who underwent instrumented fusion than in patients with less complex surgery.

Nonanemic patients do not benefit from autologous blood donation before total knee replacement

A retrospective analysis of 221 patients undergoing unilateral total knee arthroplasty between January 2007 and April 2008 was performed to look at rates of total transfusions, allogenic transfusions, and autogenic transfusions. Two senior surgeons performed all the surgeries. During that period, patients in group A (129 patients) all donated one unit of autologous blood and patients in group B (92 patients) did not donate. Within both groups, patients were further divided by preoperative hemoglobin level as either anemic or non-anemic. A hemoglobin of 12.5 g/dL was used as the cutoff. Ninety-eight patients in group A (76%) required autologous blood. Patients in group A received a higher total number of transfusions (0.93 per patient) than those in group B (0.33 per patient; p < 0.001). The rate of allogenic transfusion was lower for group A (14%) than for group B (25%; p < 0.033). The reduction of allogenic transfusions associated with preoperative autologous blood donation was confined to anemic patients (29% in group A vs 72% in group B; p = 0.0006). There was no difference in allogenic blood transfusions in non-anemic patients between group A (8%) and group B (9%; p = 0.91). Limiting autologous blood donation to anemic patients decreased cost compared to routine autologous blood donation (US $256.63/patient versus US $511.44/patient) without exposing patients to increased allogenic blood transfusions. Targeted blood management in total knee replacement surgery decreases transfusion rates and reduces cost.

Prospective randomized evaluation of the need for blood transfusion during primary total hip arthroplasty with use of a bipolar sealer

BACKGROUND

Blood loss during total hip arthroplasty can be substantial and may lead to adverse patient outcomes and increased health-care costs. Many blood-management options are available for these procedures. The purpose of the present study was to test the hemostatic efficacy of a bipolar sealer used during total hip arthroplasty in order to determine whether its use results in significantly lower transfusion requirements and/or improved clinical, functional, and health-related quality-of-life outcomes in healthy patients.

METHODS

This prospective, single-center, randomized, double-blinded study was designed to enroll a total of 140 patients. Patients with a low preoperative hemoglobin level or a history of bleeding abnormalities and other medical conditions were excluded. Patients were randomized to either the treatment arm (radiofrequency energy with use of the Aquamantys 6.0 bipolar sealer) or control arm (standard Bovie electrocautery). The primary outcome measure was the transfusion requirement, and the secondary outcome measures were intraoperative estimated blood loss, postoperative hemoglobin levels, perioperative narcotic usage, length of hospital stay, postoperative pain scores, and postoperative function as measured with the Harris hip score and the Short Form-12 quality-of-life score.

RESULTS

Seventy-one patients were assigned to the treatment arm, and sixty-nine were assigned to the control arm. The mean number of units of blood transfused for all patients in the study and control arms were 0.38 and 0.44, respectively (p = 0.72). The transfusion requirements were similar in the two groups, with fifteen of seventy-one patients in the treatment arm and fourteen of sixty-nine patients in the control arm requiring a transfusion (p = 0.9). No significant differences were detected between the groups in terms of estimated blood loss, postoperative hemoglobin levels, perioperative narcotic usage, length of hospital stay, postoperative pain scores, Harris hip scores, or Short Form-12 scores.

CONCLUSIONS

In this patient population, there were no significant differences between the treatment and control groups in terms of the need for blood transfusions or overall blood loss. Given these findings, we have discontinued the use of this bipolar sealing device in uncomplicated primary total hip arthroplasty patients at our institution.

LEVEL OF EVIDENCE

Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

Nonanemic patients do not benefit from autologous blood donation before total hip replacement

To avoid the potential risks of allogeneic transfusion during total hip arthroplasty (THA), the use of preoperative autologous blood donation (PABD) has been utilized. We performed a retrospective chart review of 283 patients undergoing THA that either donated 1 U of autologous blood (188 patients) or did not donate autologous blood before surgery (95 patients) in order to investigate the difference in postoperative transfusion rate (autologous and allogeneic), the incidence of allogeneic transfusion, and the difference in cost of each protocol. In addition, the study compared transfusion rates in patients with and without preoperative anemia (hemoglobin (Hb) ≤ 12.5 g/dL). At 0.75 transfusions per patient versus 0.22 transfusions per patient, the PABD patients had a significantly higher overall transfusion rate. PABD significantly reduced the need for allogeneic blood in anemic patients (Hb ≤ 12.5 g/dL) from 52.6% to 11.8%. PABD did not have the same affect in nonanemic patients (allogeneic transfusion rate 5.7% versus 4.0%). The study demonstrated that nonanemic patients undergoing THA do not benefit from PABD, but it is effective for anemic patients.

Preoperative use of epoietin beta in total hip replacement: a prospective study

OBJECTIVE

Epoietin (EPO) effectively decreases perioperative blood transfusion requirements. We evaluated the feasibility of using EPO beta to increase haemoglobin levels before total hip replacement (THR) and reduce transfusion.

MATERIALS AND METHODS

One hundred and seventy-one patients undergoing primary THR were included in this prospective observational study. Patients with initial haemoglobin level <130 g l−1 received EPO beta subcutaneously in a four-dose regimen. Haemoglobin levels were measured at baseline, before surgery, and at postoperative days 1 and 5.

RESULTS

Twenty-eight patients received EPO beta preoperatively, 143 were not treated including 42 with initial haemoglobin level <130 g l−1. Haemoglobin increased by 29 ± 9 g l−1 in the low Hb + EPO group versus 2 ± 1 g l−1 for the other patients. In the low Hb + EPO group 3.6% were transfused, in the low HB group 45.2% (P = 0.001) and in the normal Hb group 11.9% (P = 0.2).

CONCLUSIONS

Preoperative EPO beta increases haemoglobin level and reduces transfusion frequency in anaemic patients before total joint replacement. It could play a major role in the management of perioperative blood loss in orthopaedic surgery.

Blood transfusion requirement prediction in patients undergoing primary total hip and knee arthroplasty

The aim of this study was to identify the clinical factors associated with the need for peri-operative blood transfusion in non-anaemic patients undergoing hip or knee arthroplasty. We prospectively evaluated 162 consecutive patients who underwent total hip or knee arthroplasty. Analysis was performed to establish the relationship between all independent variables and the need for postoperative transfusion. Univariate analysis revealed a significant relationship between the need for postoperative blood transfusion and the pre-operative haemoglobin levels (P= 0.001), weight (P= 0.019) and age (P= 0.018). Multivariate analysis identified a significant relationship only between the need for transfusion and the pre-operative haemoglobin level (P= 0.0001). The pre-operative haemoglobin level of the patient was the only variable to independently predict the need for blood transfusion after primary hip or knee arthroplasty.

Effectiveness of autologous fibrin tissue adhesive in reducing postoperative blood loss during total hip arthroplasty: a prospective randomised study of 100 cases

PURPOSE

To evaluate the effectiveness of autologous fibrin tissue adhesive (auto-FTA) in reducing blood loss during cementless total hip arthroplasty (THA).

METHODS

From September 2000 to August 2001, 100 patients who predonated 400 ml of autologous blood were randomised to undergo either standard treatment with auto-FTA (auto-FTA group) or standard treatment alone (control group). The volume of postoperative blood loss and the decrease in haemoglobin level were measured. All patients were followed up for 3 years to evaluate the rate of bone ingrowth and heterotopic ossification.

RESULTS

The mean postoperative blood loss was 580 ml (standard deviation [SD], 240 ml) in the auto-FTA group and 810 ml (SD, 341 ml) in the control group; the difference was significant (230 ml, p<0.001). The decrease in haemoglobin concentration was 17 g/l (SD, 11 g/l) in the auto-FTA group and 22 g/l (SD, 12 g/l) in the control group. The difference was significant (5 g/l, p=0.03). The percentage of total blood loss of >1200 ml in any single patient was significantly lower in the auto-FTA group (4%) than in the control group (20%) [p=0.01].

CONCLUSION

Auto-FTA is a safe and effective means of reducing perioperative blood loss in THA.

A model for clinical estimation of perioperative hemorrhage

The purpose of this study was to assess the accuracy of estimated blood loss (EBL) as a reliable predictor of actual blood loss during orthopedic procedures. Between 1999 and 2002, 198 orthopedic cases were reviewed. A retrospective review compiled preoperative and postoperative demographic and laboratory data from the surgical patients. Estimated blood loss data was collected from the perioperative and anesthesia reports. Statistical analysis of EBL vs. change in hemoglobin yielded a correlation coefficient of 0.189 and a p value of 0.008. We used multiple linear regression to obtain a model to predict change in hemoglobin based on EBL and the intravenous fluids received. The model is as follows: predicted change in hemoglobin = 1.001 x estimated blood loss (in liters) + 0.441 x intravenous fluids received (in liters) + 2.334. The study population included 198 patients, 126 males and 72 females, who met our inclusion criteria. The mean age was 68.1 years (range: SD 12.5), including 126 males (64%) and 72 females (37%). The mean amount of perioperative intravenous fluids given was 1,732 mL (SD: 773). The mean surgical time was 64.8 minutes (SD: 23.1). The mean preoperative hematocrit and hemoglobin levels were 40.9 g/dL (SD: 4.3) and 13.9 g/dL (SD: 1.6), respectively. The mean postoperative hematocrit and hemoglobin levels were 32.0 g/dL (SD: 6.0) and 10.7 g/dL (SD: 1.6), respectively. The mean difference of preoperative hemoglobin vs. postoperative hemoglobin was 3.3 g/dL (SD 2.1). In this retrospective study, clinical estimation of blood loss was closely correlated with actual change in perioperative hemoglobin. Accurately predicting the postoperative hemoglobin level may prevent many unnecessary blood transfusions and related complications.

A prospective, randomized study of preoperative autologous donation for hip replacement surgery

BACKGROUND

Preoperative autologous blood donation is commonly performed to meet potential perioperative transfusion needs and is a common practice prior to total hip arthroplasty. Using standardized transfusion guidelines, we prospectively analyzed the effectiveness of preoperative autologous donation as a method for decreasing allogeneic transfusion among patients undergoing unilateral primary total hip replacement who were eligible to donate autologous blood.

METHODS

Patients who were scheduled for primary total hip replacement surgery and who had a preoperative baseline hemoglobin level >or=120 g/L were randomized either to donate two units of blood (autologous donors) or not to donate any blood (nondonors). The donors and nondonors were compared with regard to demographic data, blood-loss volumes, hemoglobin measurements, and transfusion rates. Randomization continued until data were obtained from at least forty patients per treatment group.

RESULTS

Of the ninety-six patients who completed the study, forty-two were autologous donors and fifty-four were nondonors. There were no significant differences between the donors and nondonors with regard to age, male:female ratio, estimated blood volume, baseline physical condition, or operative blood loss. The hemoglobin values at the time of enrollment (baseline), at the time of hospital discharge, and six weeks postoperatively were not significantly different between the two groups, although values at the time of admission (129 +/- 13 g/L versus 138 +/- 12 g/L) and in the recovery room (104 +/- 12 g/L versus 115 +/- 13 g/L) were significantly lower in the autologous donor group (p < 0.05). No patient in either group required an allogeneic transfusion. Twenty-nine (69%) of the forty-two donors received an autologous transfusion. Thirty-four (41%) of eighty-two autologous units were wasted. At a charge of $379 per autologous unit, there was an additional cost of $758 for each patient in the donor group.

CONCLUSIONS

Preoperative autologous donation provided no benefit for nonanemic patients undergoing primary total hip replacement surgery. Preoperative autologous donation increased the likelihood of autologous transfusion, wastage of predonated units, and costs.

Perioperative blood salvage as an alternative to predonating blood for primary total knee and hip arthroplasty

A total of 200 consecutive patients who underwent primary total knee or hip arthroplasty were reviewed to assess the efficacy of perioperative blood salvage and retransfusion. Five of 132 (3.8%) patients undergoing total knee arthroplasty and 3 of 68 (4.4%) patients undergoing total hip arthroplasty required allogeneic transfusion in addition to retransfusion of salvaged autologous blood. The risk of receiving allogeneic transfusion in addition to retransfusion of salvaged blood was 1.2% (2 of 173) in patients with a preoperative hematocrit of > or=37%. The risk of requiring allogeneic transfusion was 22% (6 of 27) in patients with a preoperative hematocrit of <or=37% (P<or=.01). Perioperative blood salvage is safe and cost-effective and makes it possible to discontinue the practice of predonating blood for primary total knee arthroplasty and total hip arthroplasty in patients with a preoperative hematocrit >37%.

Efficacy of preoperative autologous blood donation: analysis of blood loss and transfusion practice in total hip replacement

STUDY OBJECTIVE

To determine the frequency of allogeneic transfusion for total hip replacement (THR) surgery and to examine the efficacy of preoperative autologous blood donation (PABD) under specified, standardized blood transfusion guidelines.

DESIGN

Prospective, nonrandomized study.

SETTING

University medical center.

PATIENTS

All ASA physical status I, II, III, and IV patients undergoing single, primary, THR surgery from April 1998 to March 1999.

INTERVENTIONS

All patients received standardized transfusion and anticoagulation therapy. Demographic, blood loss, and transfusion data were collected and compared between all patients participating in PABD (donors) and patients not participating in PABD (nondonors). Overall allogeneic blood exposure was established. Since most anemic patients could not participate in PABD, allogeneic transfusion frequency was also examined in a subset of nonanemic patients (hemoglobin > or =12 g/dL) who were potentially able to participate in PABD.

MEASUREMENTS AND MAIN RESULTS

n = 231 patients, 142 donors and 89 nondonors. Mean estimated blood volume (EBV) of donors was 4991 +/- 1042 mL versus nondonors 4631 +/- 1108 mL (p < 0. 01). ASA physical status I-II/III-IV among donors was 118/24 versus nondonors 61/28 (p < 0.01). Overall allogeneic blood exposure was 22% (51/231). Allogeneic transfusion frequency for all donors was 15% (22/142) versus nondonors 33% (29/89) (p < 0.05). Among nonanemic patients, donor versus nondonor EBV and ASA physical status I-II/III-IV were 5074 +/- 1019 mL versus 4743 +/- 1172 mL and 107/20 versus 48/15 (p = NS); allogeneic transfusion frequency reduced to 13% (16/127) versus 17% (11/63) (p = NS), respectively.

CONCLUSIONS

Allogeneic blood exposure was >10% despite the use of PABD. The efficacy of PABD has been obscured by the fact that donors of autologous blood tend to be larger and healthier than nondonors. After exclusion of anemic patients, autologous donors and nondonors were clinically comparable and the difference in allogeneic blood exposure was not statistically significant. PABD offers only a modest, if any, benefit for THR surgery.

Comparison of acute normovolemic hemodilution and preoperative autologous blood donation in clinical practice

STUDY OBJECTIVE

To compare, by model simulation, acute normovolemic hemodilution (ANH) and preoperative autologous blood donation (PABD) to predict their efficacy in current clinical practice. To discuss their similarities and offer guidelines based on expected operative blood loss.

DESIGN

Model simulation using data obtained from total hip arthroplasty procedures.

SETTING

University medical center.

PATIENTS

91 patients who participated in PABD undergoing single, primary, total hip replacement surgeries from January to December 1997.

INTERVENTIONS

A nonanemic (Hb baseline 14 g/dL), average-sized patient (estimated blood volume 5,000 mL) who donated two units by either PABD or ANH was assumed for model simulation. The Hb-final, as a function of 250-mL blood loss increments after retransfusion of two autologous units, was calculated for each technique and compared to a control (nondonor) to predict the effectiveness of PABD and ANH in conserving red cell mass. Data from hip arthroplasties over a 12-month period were used to determine the parameters for the model. Results were subjected to regression analysis and tested for parallelism of slopes, with p < 0.05 accepted to indicate a statistical difference.

MAIN RESULTS

The difference in Hb-final between PABD and ANH was not statistically different over a wide range of blood loss. When compared to control, there was no difference in Hb-final measurements in the estimated blood loss (EBL) range of less than 1,000 mL. ANH and PABD provide some benefit when EBL is greater than 1,500 mL in nonanemic, average-sized patients. As blood loss increases, the benefit of autologous collection becomes more clinically evident.

CONCLUSION

PABD exemplifies a "chronic" form of ANH in current clinical practice and offers little advantage over ANH as a blood conservation technique for high-blood-loss operations. When surgical blood loss is predictably mild to moderate (range 250 to 1,000 mL), neither blood conservation technique is necessary.

Preoperative autologous donation for total joint arthroplasty. An analysis of risk factors for allogenic transfusion

BACKGROUND

While autologous blood is commonly predonated to provide replacement of blood lost in orthopaedic procedures, few studies of patients managed with total joint replacement have addressed the problem of which patients are likely to benefit from an autologous blood-donation program.

METHODS

A retrospective analysis of 489 consecutive patients who had had a total joint arthroplasty was performed to identify the risk factors for allogenic transfusion and to further define the indications for preoperative autologous blood donation. The operations included 247 total knee replacements (157 unilateral primary, thirty-two revision, and twenty-nine one-stage bilateral primary procedures) and 271 total hip replacements (163 primary and 108 revision procedures). Fifty-four percent (264) of the 489 patients donated a total of 527 units of blood (average, 2.0 units per patient) preoperatively.

RESULTS

One hundred and ninety-one patients (39 percent) required a transfusion of autologous blood or allogenic blood, or both. One hundred and thirty-one patients (27 percent) received autologous blood, and eighty-two patients (17 percent) received a transfusion of allogenic blood; twenty-two patients (4 percent) received both autologous and allogenic blood. Neither form of transfusion caused serious complications. Fifty-six percent (295) of the 527 units of autologous blood were discarded. Autologous donation significantly decreased the requirements for allogenic transfusion (relative risk, 0.1; p<0.0001). It also caused the level of hemoglobin to decrease an average of 12.2 grams per liter from the time before donation to the time before the operation (p<0.0001). Factors that increased the risk for allogenic transfusion were a revision knee or hip procedure or a one-stage bilateral primary knee replacement (relative risk, 5.7; p<0.0001), an initial hemoglobin level of less than 130 grams per liter (relative risk, 5.6; p<0.0001), and an age of sixty-five years or older (relative risk, 2.8; p = 0.02). None of the sixty-seven patients who had a primary knee or hip arthroplasty and an initial hemoglobin level of 150 grams per liter or more required an allogenic transfusion. In addition, none of the sixty-three patients who had a primary arthroplasty, an initial hemoglobin level of between 130 and less than 150 grams per liter, and an age of less than sixty-five years required an allogenic transfusion. Eighty-three percent (115) of the 138 autologous units donated by the seventy patients in these two groups were discarded. These wasted units accounted for 39 percent of the 295 discarded units for the entire study sample.

CONCLUSIONS

The efficiency of collection of autologous blood can be improved by identifying patients who have a very low risk of transfusion according to the type of arthroplasty, the initial level of hemoglobin, and age. Patients who have an initial hemoglobin level of at least 150 grams per liter or an initial hemoglobin level of between 130 and 150 grams per liter and an age of less than sixty-five years have a minimal risk of needing a transfusion during or after a primary total joint replacement. These patients should be apprised of their low risk so that they can make an informed decision regarding preoperative autologous donation.

An analysis of blood management in patients having a total hip or knee arthroplasty

Three hundred and thirty orthopaedic surgeons in the United States participated in a study of transfusion requirements associated with total joint arthroplasty. A total of 9482 patients (3920 patients who had a total hip replacement and 5562 patients who had a total knee replacement) were evaluated prospectively from September 1996 through June 1997. Of those patients, 4409 (46 percent [57 percent of the patients who had a hip replacement and 39 percent of the patients who had a knee replacement]) had a blood transfusion. Two thousand eight hundred and ninety patients (66 percent) received autologous blood, and 1519 patients (34 percent) received allogenic blood. Ordered logistic regression analysis showed the most important predictors of the transfusion of allogenic blood to be a low baseline hemoglobin level and a lack of predonated autologous blood. Preoperative donation of autologous blood decreases the risk of transfusion of allogenic blood; however, inefficiencies in the procedures for obtaining autologous blood were identified. Sixty-one percent (5741) of the patients had predonated blood for autologous transfusion, but 4464 (45 percent) of the 9920 units of the predonated autologous blood were not used. Primary procedures and revision total knee arthroplasty were associated with the greatest number of wasted autologous units. Of the 5741 patients who had predonated blood, 503 (9 percent) needed a transfusion of allogenic blood. The frequency of allogenic blood transfusion varied with respect to the type of operative procedure (revision total hip arthroplasty and bilateral total knee arthroplasty were associated with the highest prevalence of such transfusions) and with a baseline hemoglobin level of 130 grams per liter or less. Transfusion of allogenic blood was also associated with infection (p < or = 0.001), fluid overload (p < or = 0.001), and increased duration of hospitalization (p < or = 0.01). These latter findings warrant further evaluation in controlled studies.

Global blood management in orthopaedic surgery

Blood loss tends to be significant in many orthopaedic procedures because of the nature of the tissues and the inability to cauterize or coagulate bleeding bony surfaces. Regional hypotensive anesthesia has been useful in reducing blood loss particularly for joint replacement. A spectrum of measures is available to retrieve autologous blood and reinfuse it. The loop consists of predeposit autologous blood, preoperative hemodilution, intraoperative and postoperative red cell retrieval, and reinfusion. The safety of autologous blood has been accepted universally, but the measures to preserve it must be used judiciously to avoid excessive cost and, most importantly, ensure patient safety.

Blood salvage after total hip and total knee arthroplasty

We performed a prospective study to determine the effect of postoperative collection and reinfusion of unwashed, filtered, salvaged blood alone and in combination with preoperative predeposited blood on the transfusion requirements of 375 patients treated with a total hip or total knee replacement. 208 patients were managed with postoperative blood salvage with use of the CBC ConstaVac autotransfusion system and closed suction drainage. Another 50 patients predeposited 1-4 units of autologous blood, before the operation, in addition to postoperative blood salvage. The remaining 117 patients were used as controls and were transfused with homologous blood from the blood bank. Postoperative reinfusion of salvaged blood decreased the need for homologous transfusion after hip and knee arthroplasty (mean 2.7 units) compared to controls (mean 4.2 units). The combination of postoperative reinfusion of salvaged blood and predeposited autologous blood was associated with the lowest requirements for homologous blood transfusions (mean 1.7 units).

Autologous blood transfusion in hip replacement. No effect on blood loss but less increase of plasminogen activator inhibitor in a randomized series of 80 patients

80 patients underwent total hip replacement (THR) for primary coxarthrosis. In a randomized study, half of them donated 2 units of blood before operation. One unit was collected 4 weeks and one 2 weeks before the scheduled THR. All except 1 patient tolerated the predonations well. Total blood losses were similar in both groups. Additional bank blood was given in 7/38 in the predonation group, compared to 29/40 in the control group. Hemostatic parameters were studied in 10 consecutive patients in each group. Plasminogen activator inhibitor 1 (PAI-1), a possible risk parameter for thromboembolism, was significantly more increased postoperatively in the control group, which received only homologous blood. Platelet count, prothrombin complex, antithrombin III and von Willebrand factor antigen were significantly reduced and C reactive protein increased after surgery in both groups. We recommend predonation of 2 autologous units before a primary THR. In most cases, such predonation makes homologous blood transfusion unnecessary. The use of predonated blood causes no reduction of blood loss in THRs, but the increase in PAI-1 seen after homologous transfusions is avoided.