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.
- Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am. 1999;81(1):2–10.
- Biesma DH, Marx JJ, van de Wiel A. Collection of autologous blood before elective hip replacement. A comparison of the results with the collection of two and four units. J Bone Joint Surg Am. 1994;76(10):1471–1475.
- Billote DB, Glisson SN, Green D, Wixson RL. A prospective, randomized study of preoperative autologous donation for hip replacement surgery. J Bone Joint Surg Am. 2002; 84-A(8):1299–1304.
- Bong MR, Patel V, Chang E, Issack PS, Hebert R, Di Cesare PE. Risks associated with blood transfusion after total knee arthroplasty. J Arthroplasty. 2004;19(3):281–287. CrossRef
- Couvret C, Laffon M, Baud A, Payen V, Burdin P, Fusciardi J. A restrictive use of both autologous donation and recombinant human erythropoietin is an efficient policy for primary total hip or knee arthroplasty. Anesth Analg. 2004;99(1):262–271. CrossRef
- Cushner FD, Hawes T, Kessler D, Hill K, Scuderi GR. Orthopaedic-induced anemia: the fallacy of autologous donation programs. Clin Orthop Relat Res. 2005;(431):145–149.
- Cushner FD, Lee GC, Scuderi GR, Arsht SJ, Scott WN. Blood loss management in high-risk patients undergoing total knee arthroplasty: a comparison of two techniques. J Knee Surg. 2006;19(4):249–253.
- Deutsch A, Spaulding J, Marcus RE. Preoperative epoetin alfa vs autologous blood donation in primary total knee arthroplasty. J Arthroplasty. 2006;21(5):628–635. CrossRef
- Etchason J, Petz L, Keeler E, Calhoun L, Kleinman S, Snider C, Fink A, Brook R. The cost effectiveness of preoperative autologous blood donations. N Engl J Med. 1995;332(11):719–724. CrossRef
- Faris PM, Ritter MA, Abels RI. The effects of recombinant human erythropoietin on perioperative transfusion requirements in patients having a major orthopaedic operation. The American Erythropoietin Study Group. J Bone Joint Surg Am. 1996;78(1):62–72.
- Forgie MA, Wells PS, Laupacis A, Fergusson D. Preoperative autologous donation decreases allogenic transfusion but increases exposure to all red blood cell transfusion: results of a meta-analysis. International Study of Perioperative Transfusion (ISPOT) Investigators. Arch Intern Med. 1998;158(6):610–616. CrossRef
- Green WS, Toy P, Bozic KJ. Cost minimization analysis of preoperative erythropoietin vs autologous and allergenic blood donation in total joint arthroplasty. J Arthroplasty. 2010;25(1):93–96. CrossRef
- Hardwick ME, Morris BM, Colwell CW, Jr. Two-dose epoetin alfa reduces blood transfusions compared with autologous donation. Clin Orthop Relat Res. 2004;(423):240–244.
- Hatzidakis AM, Mendlick RM, McKillip T, Reddy RL, Garvin KL. Preoperative autologous donation for total joint arthroplasty. An analysis of risk factors for allogenic transfusion. J Bone Joint Surg Am. 2000;82(1):89–100.
- Lee GC, Cushner FD. The effects of preoperative autologous donations on perioperative blood levels. J Knee Surg. 2007;20(3):205–209.
- Martinez V, Monsaingeon-Lion A, Cherif K, Judet T, Chauvin M, Fletcher D. Transfusion strategy for primary knee and hip arthroplasty: impact of an algorithm to lower transfusion rates and hospital costs. Br J Anaesth. 2007;99(6):794–800. CrossRef
- Slappendel R, Dirksen R, Weber EW, van der Schaaf DB. An algorithm to reduce allogenic red blood cell transfusions for major orthopedic surgery. Acta Orthop Scand. 2003;74(5):569–575. CrossRef
- Walsh M, Preston C, Bong M, Patel V, Di Cesare PE. Relative risk factors for requirement of blood transfusion after total hip arthroplasty. J Arthroplasty. 2007;22(8):1162–1167. CrossRef
- Keating EM, Meding JB, Faris PM, Ritter MA. Predictors of transfusion in elective knee surgery. Clin Orthop Relat Res. 1998;357:50–59. CrossRef
- Nonanemic Patients Do Not Benefit from Autologous Blood Donation Before Total Knee Replacement
Volume 7, Issue 2 , pp 141-144
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- primary total knee replacement
- autologous blood
- blood management