Does Single Use of an Autologous Transfusion System in TKA Reduce the Need for Allogenic Blood?: A Prospective Randomized Trial
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Mechanical autotransfusion systems for washed shed blood (WSB) were introduced to reduce the need for postoperative allogenic blood transfusions (ABTs). Although some authors have postulated decreased requirements for ABT by using autologous retransfusion devices, other trials, mostly evaluating retransfusion devices for unwashed shed blood (USB), verified a small or no benefit in reducing the need for postoperative ABT. Because of these contradictory findings it is still unclear whether autologous retransfusion systems for WSB can reduce transfusion requirements.
We therefore asked whether one such autologous transfusion system for WSB can reduce the requirements for postoperative ABT.
In a prospective, randomized, controlled study, we enrolled 151 patients undergoing TKA. In Group A (n = 76 patients), the autotransfusion system was used for a total of 6 hours (intraoperatively and postoperatively) and the WSB was retransfused after processing. In Control Group B (n = 75 patients), a regular drain without suction was used. We used signs of anemia and/or a hemoglobin value less than 8 g/dL as indications for transfusion. If necessary, we administered one or two units of allogenic blood.
Twenty-three patients (33%) in Group A, who received an average of 283 mL (range, 160–406 mL) of salvaged blood, needed a mean of 2.1 units of allogenic blood, compared with 23 patients (33%) in Control Group B who needed a mean of 2.1 units of allogenic blood.
We found the use of an autotransfusion system did not reduce the rate of postoperative ABTs.
Level of Evidence
Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
- Amin, A, Watson, A, Mangwani, J, Nawabi, D, Ahluwalia, R, Loeffler, M (2008) A prospective randomised controlled trial of autologous retransfusion in total knee replacement. J Bone Joint Surg Br. 90: pp. 451-454 CrossRef
- Biedler, AE, Schneider, SO, Seyfert, U, Rensing, H, Grenner, S, Girndt, M, Bauer, I, Bauer, M (2002) Impact of alloantigens and storage-associated factors on stimulated cytokine response in an in vitro model of blood transfusion. Anesthesiology. 97: pp. 1102-1109 CrossRef
- Buchta, C, Hanslik-Schnabel, B, Weigl, R, List, J, Körmöczi, GF, Macher, M, Heinzl, H, Höcker, P, Wanivenhaus, A, Kurz, M (2005) Quality of drainage blood: survival of red cells after re-transfusion and content of free hemoglobin and potassium. Int J Surg. 3: pp. 250-253 CrossRef
- Clark, CR (2009) Perioperative blood management in total hip arthroplasty. Instr Course Lect. 58: pp. 167-172
- Clark, CR, Spratt, KF, Blondin, M, Craig, S, Fink, L (2006) Perioperative autotransfusion in total hip and knee arthroplasty. J Arthroplasty. 21: pp. 23-35 CrossRef
- Colwell, CW, Beutler, E, West, C, Hardwick, ME, Morris, BA (2002) Erythrocyte viability in blood salvaged during total joint arthroplasty with cement. J Bone Joint Surg Am. 84: pp. 23-25 CrossRef
- Trujillo, MM, Carrero, A, Muñoz, M (2008) The utility of the perioperative autologous transfusion system OrthoPAT® in total hip replacement surgery: a prospective study. Arch Orthop Trauma Surg. 128: pp. 1031-1038 CrossRef
- Garvin, KL, Feschuk, CA, Sekundiak, TD, Lyden, ER (2005) Blood salvage and allogenic transfusion needs in revision hip arthroplasty. Clin Orthop Relat Res. 441: pp. 205-209 CrossRef
- Gombotz, H, Rehak, PH, Shander, A, Hofmann, A (2007) Blood use in elective surgery: the Austrian benchmark study. Transfusion. 47: pp. 1468-1480 CrossRef
- Goodnough LT. Risks of blood transfusion. Anesthesiol Clin North America. 2005;23:241–252, v.
- Grosvenor, D, Goyal, V, Goodman, S (2000) Efficacy of postoperative blood salvage following total hip arthroplasty in patients with and without deposited autologous units. J Bone Joint Surg Am. 82: pp. 951-954
- Hansen, E, Pawlik, M (2004) Reasons against the retransfusion of unwashed wound blood. Transfusion. 44: pp. 45S-53S CrossRef
- Harling, DW (1995) Consistency of ASA grading. Anaesthesia. 50: pp. 659
- Hazarika, S, Bhattacharya, R, Bhavikatti, M, Dawson, M (2010) A comparison of post-op haemoglobin levels and allogeneic blood transfusion rates following total knee arthroplasty without drainage or with reinfusion drains. Acta Orthop Belg. 76: pp. 74-78
- Hendrych, J (2006) [Use of post-operative drainage and auto-transfusion sets in total knee arthroplasty] [in Czech]. Acta Chir Orthop Traumatol Cech. 73: pp. 34-38
- Jones, HW, Savage, L, White, C, Goddard, R, Lumley, H, Kashif, F, Gurusany, K (2004) Postoperative autologous blood salvage drains are they useful in primary uncemented hip and knee arthroplasty? A prospective study of 186 cases. Acta Orthop Belg. 70: pp. 466-473
- Lakshmanan, P, Purushothaman, B, Sharma, A (2010) Impact of reinfusion drains on hemoglobin level in total knee arthroplasty. Am J Orthop (Belle Mead NJ). 39: pp. 70-74
- Martin, A, Strempel, A (2006) Transfusion of autologous blood from reinfusion systems in total knee arthroplasty. Int Orthop. 30: pp. 541-544 CrossRef
- Mauerhan, DR, Nussman, D, Mokris, JG, Beaver, WB (1993) Effect of postoperative reinfusion systems on hemoglobin levels in primary total hip and total knee arthroplasties: a prospective randomized study. J Arthroplasty. 8: pp. 523-527 CrossRef
- Moonen, AF, Knoors, NT, Os, JJ, Verburg, AD, Pilot, P (2007) Retransfusion of filtered shed blood in primary total hip and knee arthroplasty: a prospective randomized clinical trial. Transfusion. 47: pp. 379-384 CrossRef
- Moonen, AF, Neal, TD, Pilot, P (2006) Peri-operative blood management in elective orthopaedic surgery: a critical review of the literature. Injury. 37: pp. S11-S16 CrossRef
- Muñoz, M, Ariza, D, Garcerán, MJ, Gómez, A, Campos, A (2005) Benefits of postoperative shed blood reinfusion in patients undergoing unilateral total knee replacement. Arch Orthop Trauma Surg. 125: pp. 385-389 CrossRef
- Muñoz, M, García-Vallejo, JJ, Ruiz, MD, Romero, R, Olalla, E, Sebastián, C (2004) Transfusion of post-operative shed blood: laboratory characteristics and clinical utility. Eur Spine J. 13: pp. S107-S113 CrossRef
- Muñoz, M, Kühlmorgen, B, Ariza, D, Haro, E, Marroquí, A, Ramirez, G (2007) Which patients are more likely to benefit from postoperative shed blood salvage after unilateral total knee replacement? An analysis of 581 consecutive procedures. Vox Sang. 92: pp. 136-141 CrossRef
- Muñoz Gómez M, Ariza Villanueva D, Romero Ruiz A, Muñoz Morán E, Prat Arrojo I, Gómez Luque A. [Evaluation of the OrthoPAT autologous transfusion system by experimental models simulating intra- and postoperative blood salvage][in Spanish]. Rev Esp Anestesiol Reanim. 2005;52:321–327.
- Newman, JH, Bowers, M, Murphy, J (1997) The clinical advantages of autologous transfusion: a randomized, controlled study after knee replacement. J Bone Joint Surg Br. 79: pp. 630-632 CrossRef
- Pierson, JL, Hannon, TJ, Earles, DR (2004) A blood-conservation algorithm to reduce blood transfusions after total hip and knee arthroplasty. J Bone Joint Surg Am. 86: pp. 1512-1518
- Pola, E, Papaleo, P, Santoliquido, A, Gasparini, G, Aulisa, L, Santis, E (2004) Clinical factors associated with an increased risk of perioperative blood transfusion in nonanemic patients undergoing total hip arthroplasty. J Bone Joint Surg Am. 86: pp. 57-61
- Ralley, FE, Berta, D, Binns, V, Howard, J, Naudie, DD (2010) One intraoperative dose of tranexamic acid for patients having primary hip or knee arthroplasty. Clin Orthop Relat Res. 468: pp. 1905-1911 CrossRef
- Reize, P, Endele, D, Rudert, M, Wülker, N (2006) [Postoperative autologous transfusion from blood drainage after total hip joint arthroplasty: how much value is really there?] [in German]. Z Orthop Ihre Grenzgeb. 144: pp. 400-404 CrossRef
- Rollo, VJ, Hozack, WJ, Rothman, RH, Chao, W, Eng, KO (1995) Prospective randomized evaluation of blood salvage techniques for primary total hip arthroplasty. J Arthroplasty. 10: pp. 532-539 CrossRef
- Rosencher, N, Kerkkamp, HE, Macheras, G, Munuera, LM, Menichella, G, Barton, DM, Cremers, S (2003) Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion. 43: pp. 459-469 CrossRef
- Schreiber, GB, Busch, MP, Kleinman, SH, Korelitz, JJ (1996) The risk of transfusion-transmitted viral infections: the Retrovirus Epidemiology Donor Study. N Engl J Med. 334: pp. 1685-1690 CrossRef
- Smith, LK, Williams, DH, Langkamer, VG (2007) Post-operative blood salvage with autologous retransfusion in primary total hip replacement. J Bone Joint Surg Br. 89: pp. 1092-1097 CrossRef
- Southern, EP, Huo, MH, Mehta, JR, Keggi, KJ (1995) Unwashed wound drainage blood: what are we giving our patients?. Clin Orthop Relat Res. 320: pp. 235-246
- Steinberg, EL, Ben-Galim, P, Yaniv, Y, Dekel, S, Menahem, A (2004) Comparative analysis of the benefits of autotransfusion of blood by a shed blood collector after total knee replacement. Arch Orthop Trauma Surg. 124: pp. 114-118 CrossRef
- Strümper, D, Weber, EW, Gielen-Wijffels, S, Drumpt, R, Bulstra, S, Slappendel, R, Durieux, ME, Marcus, MA (2004) Clinical efficacy of postoperative autologous transfusion of filtered shed blood in hip and knee arthroplasty. Transfusion. 44: pp. 1567-1571 CrossRef
- Tobias, JD (2004) Strategies for minimizing blood loss in orthopedic surgery. Semin Hematol. 41: pp. 145-156 CrossRef
- Warner, C (2001) The use of the orthopaedic perioperative autotransfusion (OrthoPAT) system in total joint replacement surgery. Orthop Nurs. 20: pp. 29-32 CrossRef
- Waters, JH, Dyga, RM (2007) Postoperative blood salvage: outside the controlled world of the blood bank. Transfusion. 47: pp. 362-365 CrossRef
- Woolson, ST, Wall, WW (2003) Autologous blood transfusion after total knee arthroplasty: a randomized, prospective study comparing predonated and postoperative salvage blood. J Arthroplasty. 18: pp. 243-249 CrossRef
- Zacharopoulos, A, Apostolopoulos, A, Kyriakidis, A (2007) The effectiveness of reinfusion after total knee replacement: a prospective randomised controlled study. Int Orthop. 31: pp. 303-308 CrossRef
- Zarin, J, Grosvenor, D, Schurman, D, Goodman, S (2003) Efficacy of intraoperative blood collection and reinfusion in revision total hip arthroplasty. J Bone Joint Surg Am. 85: pp. 2147-2151
- Does Single Use of an Autologous Transfusion System in TKA Reduce the Need for Allogenic Blood?: A Prospective Randomized Trial
Clinical Orthopaedics and Related Research®
Volume 471, Issue 4 , pp 1319-1325
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Orthopaedic Surgery, Academic Teaching Hospital, Medical University of Innsbruck, Carinagasse 47, A-6800, Feldkirch, Austria
- 2. Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- 3. Sport Orthopaedic Clinic Bern, Münsingen, Switzerland