Targeted pre-operative autologous blood donation: a prospective study of two thousand and three hundred and fifty total hip arthroplasties
- First Online:
- 248 Downloads
Pre-operative donation of autologous blood has been widely used in elective joint replacement procedures to avoid the risks of allogeneic blood transfusions. However, the high percentage of wasted autologous blood questions the general efficacy of pre-operative autologous blood donation (PABD) for all patients undergoing hip replacement. This study prospectively investigates the impact of a targeted pre-operative autologous blood donation protocol for anaemic patients on allogeneic and overall transfusion rates in 2,350 unilateral primary total hip arthroplasty procedures.
Patients with pre-operative haemoglobin less than 12.5 g/dL were advised to donate one unit of autologous blood seven to 15 days prior to the date of surgery. The targeted protocol was followed by 2,251 patients: 280 out of 367 anaemic patients donated while 1,971 out of 1,983 non-anaemic patients did not donate.
Results showed a significantly lower rate of allogeneic transfusion for anaemic patients who predonated than anaemic patients who did not (13 % vs. 37 % respectively, p < 0.001). Overall transfusion rates for patients who followed the protocol (n = 2,251) were found to be 0.17 units/patient compared to previously reported numbers of 0.75 units/patient when routine donation was used. Among the 2,251 patients who followed the protocol, only 140 patients (6 %) had their autologous blood wasted, in contrast to values reported in the literature ranging from 14 % up to 50 %.
Targeted PABD reduces the need for allogeneic blood transfusion in anaemic patients and significantly reduces the overall number of transfusions compared to routine pre-operative autologous donation.
KeywordsAnaemia Total hip arthroplasty Blood management Preoperative autologous blood donation Allogeneic Transfusion
- 2.Newman ET, Watters TS, Lewis JS, Jennings JM, Wellman SS, Attarian DE, Grant SA, Green CL, Vail TP, Bolognesi MP (2014) Impact of perioperative allogeneic and autologous blood transfusion on acute wound infection following total knee and total hip arthroplasty. J Bone Joint Surg Am 96(4):279–284. doi:10.2106/JBJS.L.01041 PubMedCrossRefGoogle Scholar
- 7.de Andrade JR, Jove M, Landon G, Frei D, Guilfoyle M, Young DC (1996) Baseline hemoglobin as a predictor of risk of transfusion and response to Epoetin alfa in orthopedic surgery patients. Am J Orthop (Belle Mead NJ) 25(8):533–542Google Scholar
- 10.Buljan M, Nemet D, Golubic-Cepulic B, Bicanic G, Tripkovic B, Delimar D (2012) Two different dosing regimens of human recombinant erythropoietin beta during preoperative autologous blood donation in patients having hip arthroplasty. Int Orthop 36(4):703–709. doi:10.1007/s00264-011-1367-7 PubMedCentralPubMedCrossRefGoogle Scholar
- 18.Henry DA, Carless PA, Moxey AJ, O’Connell D, Forgie MA, Wells PS, Fergusson D (2002) Pre-operative autologous donation for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev (2):CD003602. doi:10.1002/14651858.CD003602