Advertisement

Archives of Orthopaedic and Trauma Surgery

, Volume 136, Issue 9, pp 1213–1226 | Cite as

A protocol avoiding allogeneic transfusion in joint arthroplasties

  • You-Sung Suh
  • Jae-Hwi NhoEmail author
  • Hyung-Suk Choi
  • Yong-Chan Ha
  • Jong-Seok Park
  • Kyung-Hoi Koo
Orthopaedic Surgery

Abstract

Introduction

Arthroplasties of hip and knee are associated with blood loss, which may lead to adverse patient outcome. Performing arthroplasties in Jehovah’s Witness patients who do not accept transfusion has been a matter of concern. We developed a protocol, which avoids transfusion in arthroplasties of Jehovah’s Witness patients, and evaluated the feasibility and safety of the protocol.

Materials and methods

The target of preoperative hemoglobin was more than 10 g/dL. When preoperative hemoglobin was lower than 10 g/dL, 4000 U erythropoietin (3 times a week) and 100 mg iron supplement (every day) were administered until the hemoglobin reached 10 g/dL. When the preoperative hemoglobin was higher than 10 g/dL, 4000 U erythropoietin and 100 mg iron supplement were administered once, before operation. During the operation, cell saver was used. Postoperatively, erythropoietin and iron supplements were administered until the hemoglobin reached 10 g/dL, similar to the preoperative protocol. We evaluated the feasibility of our protocol, perioperative complications and hematologic changes.

Results

From 2002 to 2014, 186 Witness patients visited our department. In 179 patients (96.2 %), 77 total knee arthroplasties, 69 bipolar hemiarthroplasties and 33 total hip arthroplasties were performed. The mean hemoglobin level was 12.3 g/dL preoperatively, 9.4 g/dL on postoperative day 3 and 10.3 g/dL on postoperative day 7. One patient died immediately after the arthroplasty and the remaining 178 patients survived.

Conclusions

Total joint arthroplasty could be done without transfusion using this protocol in most of our patients. The rates of infection and mortality were similar with known infection and mortality rates of arthroplasties. In patients who do not want allogeneic transfusions, our protocol is a safe alternative to perform joint arthroplasties.

Keywords

Transfusion Arthroplasty Hip Knee 

Notes

Acknowledgments

This work was supported by the Soonchunhyang University Research Fund.

Compliance with ethical standards

Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

References

  1. 1.
    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 Jt Surg Am 96(4):279–284. doi: 10.2106/JBJS.L.01041 CrossRefGoogle Scholar
  2. 2.
    Friedman R, Homering M, Holberg G, Berkowitz SD (2014) Allogeneic blood transfusions and postoperative infections after total hip or knee arthroplasty. J Bone Jt Surg Am 96(4):272–278. doi: 10.2106/JBJS.L.01268 CrossRefGoogle Scholar
  3. 3.
    Watts CD, Pagnano MW (2012) Minimising blood loss and transfusion in contemporary hip and knee arthroplasty. J Bone Jt Surg Br 94(11 Suppl A):8–10. doi: 10.1302/0301-620X.94B11.30618 CrossRefGoogle Scholar
  4. 4.
    Shemshaki H, Nourian SM, Nourian N, Dehghani M, Mokhtari M, Mazoochian F (2015) One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration. Arch Orthop Trauma Surg 135(4):573–588. doi: 10.1007/s00402-015-2189-7 CrossRefPubMedGoogle Scholar
  5. 5.
    Li N, Li P, Liu M, Wang D, Xia L (2014) Comparison between autologous blood transfusion drainage and no drainage/closed-suction drainage in primary total hip arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 134(11):1623–1631. doi: 10.1007/s00402-014-2090-9 CrossRefPubMedGoogle Scholar
  6. 6.
    Mahringer-Kunz A, Efe T, Fuchs-Winkelmann S, Schuttler KF, Paletta JR, Heyse TJ (2015) Bleeding in TKA: posterior stabilized vs. cruciate retaining. Arch Orthop Trauma Surg 135(6):867–870. doi: 10.1007/s00402-015-2209-7 CrossRefPubMedGoogle Scholar
  7. 7.
    Jauregui JJ, Kapadia BH, Banerjee S, Issa K, Su S, Harwin SF, Mont MA (2014) Blood management strategies for total hip arthroplasty in Jehovah’s Witness patients. Surg Technol Int 24:338–343PubMedGoogle Scholar
  8. 8.
    Park JH, Rasouli MR, Mortazavi SM, Tokarski AT, Maltenfort MG, Parvizi J (2013) Predictors of perioperative blood loss in total joint arthroplasty. J Bone Jt Surg Am 95(19):1777–1783. doi: 10.2106/JBJS.L.01335 CrossRefGoogle Scholar
  9. 9.
    Browne JA, Adib F, Brown TE, Novicoff WM (2013) Transfusion rates are increasing following total hip arthroplasty: risk factors and outcomes. J Arthroplast 28(8 Suppl):34–37. doi: 10.1016/j.arth.2013.03.035 CrossRefGoogle Scholar
  10. 10.
    Yoshihara H, Yoneoka D (2014) Predictors of allogeneic blood transfusion in total hip and knee arthroplasty in the United States, 2000-2009. J Arthroplast. doi: 10.1016/j.arth.2014.04.026 Google Scholar
  11. 11.
    Aguilera X, Martinez-Zapata MJ, Hinarejos P, Jordan M, Leal J, Gonzalez JC, Monllau JC, Celaya F, Rodriguez-Arias A, Fernandez JA, Pelfort X, Puig-Verdie L (2015) Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial. Arch Orthop Trauma Surg 135(7):1017–1025. doi: 10.1007/s00402-015-2232-8 CrossRefPubMedGoogle Scholar
  12. 12.
    Yi S, Tan J, Chen C, Chen H, Huang W (2014) The use of pneumatic tourniquet in total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 134(10):1469–1476. doi: 10.1007/s00402-014-2056-y CrossRefPubMedGoogle Scholar
  13. 13.
    Sabatini L, Atzori F, Revello S, Scotti L, Debiasi F, Masse A (2014) Intravenous use of tranexamic acid reduces postoperative blood loss in total knee arthroplasty. Arch Orthop Trauma Surg 134(11):1609–1614. doi: 10.1007/s00402-014-2081-x CrossRefPubMedGoogle Scholar
  14. 14.
    Ogbemudia AE, Yee SY, MacPherson GJ, Manson LM, Breusch SJ (2013) Preoperative predictors for allogenic blood transfusion in hip and knee arthroplasty for rheumatoid arthritis. Arch Orthop Trauma Surg 133(9):1315–1320. doi: 10.1007/s00402-013-1784-8 CrossRefPubMedGoogle Scholar
  15. 15.
    Park KH, Lee SR, Jin JM, Moon MS (2012) The efficacy and safety of postoperative autologous transfusion of filtered shed blood and anticoagulant prophylaxis in total knee arthroplasty patients. Knee Surg Relat Res 24(1):14–18. doi: 10.5792/ksrr.2012.24.1.14 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Toy PT, Kaplan EB, McVay PA, Lee SJ, Strauss RG, Stehling LC (1992) Blood loss and replacement in total hip arthroplasty: a multicenter study. The Preoperative Autologous Blood Donation Study Group. Transfusion 32(1):63–67CrossRefPubMedGoogle Scholar
  17. 17.
    Faris PM, Ritter MA (1998) Epoetin alfa. A bloodless approach for the treatment of perioperative anemia. Clin Orthop Relat Res 357:60–67CrossRefPubMedGoogle Scholar
  18. 18.
    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
  19. 19.
    Eschbach JW, Egrie JC, Downing MR, Browne JK, Adamson JW (1987) Correction of the anemia of end-stage renal disease with recombinant human erythropoietin. Results of a combined phase I and II clinical trial. N Engl J Med 316(2):73–78. doi: 10.1056/NEJM198701083160203 CrossRefPubMedGoogle Scholar
  20. 20.
    Winearls CG, Oliver DO, Pippard MJ, Reid C, Downing MR, Cotes PM (1986) Effect of human erythropoietin derived from recombinant DNA on the anaemia of patients maintained by chronic haemodialysis. Lancet 2(8517):1175–1178CrossRefPubMedGoogle Scholar
  21. 21.
    Moskal JT, Harris RN, Capps SG (2015) Transfusion cost savings with tranexamic acid in primary total knee arthroplasty from 2009 to 2012. J Arthroplast 30(3):365–368. doi: 10.1016/j.arth.2014.10.008 CrossRefGoogle Scholar
  22. 22.
    Harris RN, Moskal JT, Capps SG (2015) Does tranexamic acid reduce blood transfusion cost for primary total hip arthroplasty? A case-control study. J Arthroplasty 30(2):192–195. doi: 10.1016/j.arth.2014.08.020 CrossRefPubMedGoogle Scholar
  23. 23.
    Byrne MP (1976) Abdominal aortic aneurysm surgery in the Jehovah’s Witness. Use of auto transfusion. IMJ Ill Med J 150(1):87–90PubMedGoogle Scholar
  24. 24.
    Takaori M, Kimura K, Endo E (1989) Anesthesia and preoperative hemodilution for autotransfusion. Masui 38(12):1627–1632PubMedGoogle Scholar
  25. 25.
    Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB (1999) An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Jt Surg Am 81(1):2–10Google Scholar
  26. 26.
    Faris PM, Spence RK, Larholt KM, Sampson AR, Frei D (1999) The predictive power of baseline hemoglobin for transfusion risk in surgery patients. Orthopedics 22(1 Suppl):s135–s140PubMedGoogle Scholar
  27. 27.
    Keating EM, Meding JB, Faris PM, Ritter MA (1998) Predictors of transfusion risk in elective knee surgery. Clin Orthop Relat Res 357:50–59CrossRefPubMedGoogle Scholar
  28. 28.
    Borghi B, Pignotti E, Montebugnoli M, Bassi A, Corbascio M, de Simone N, Elmar K, Righi U, Laguardia AM, Bugamelli S, Cataldi F, Ranocchi R, Feoli MA, Bombardini T, Gargioni G, Franchini AG, Caroli GC (1997) Autotransfusion in major orthopaedic surgery: experience with 1785 patients. Br J Anaesth 79(5):662–664CrossRefPubMedGoogle Scholar
  29. 29.
    Bould M, Freeman BJ, Pullyblank A, Newman JH (1998) Blood loss in sequential bilateral total knee arthroplasty. J Arthroplast 13(1):77–79CrossRefGoogle Scholar
  30. 30.
    Woolson ST, Pottorff G (1993) Use of preoperatively deposited autologous blood for total knee replacement. Orthopedics 16(2):137–141 discussion 141–132 PubMedGoogle Scholar
  31. 31.
    Monreal M, Lafoz E, Llamazares J, Roncales J, Roca J, Granero X (1996) Preoperative platelet count and postoperative blood loss in patients undergoing hip surgery: an inverse correlation. Haemostasis 26(3):164–169PubMedGoogle Scholar
  32. 32.
    Nelson CL, Bowen WS (1986) Total hip arthroplasty in Jehovah’s Witnesses without blood transfusion. J Bone Jt Surg Am 68(3):350–353Google Scholar
  33. 33.
    Nelson CL, Fontenot HJ, Flahiff C, Stewart J (1998) An algorithm to optimize perioperative blood management in surgery. Clin Orthop Relat Res 357:36–42CrossRefPubMedGoogle Scholar
  34. 34.
    Nelson CL, Stewart JG (1999) Primary and revision total hip replacement in patients who are Jehovah’s Witnesses. Clin Orthop Relat Res 369:251–261CrossRefPubMedGoogle Scholar
  35. 35.
    Feagan BG, Wong CJ, Kirkley A, Johnston DW, Smith FC, Whitsitt P, Wheeler SL, Lau CY (2000) Erythropoietin with iron supplementation to prevent allogeneic blood transfusion in total hip joint arthroplasty. A randomized, controlled trial. Ann Intern Med 133(11):845–854CrossRefPubMedGoogle Scholar
  36. 36.
    Lotke PA, Faralli VJ, Orenstein EM, Ecker ML (1991) Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion. J Bone Jt Surg Am 73(7):1037–1040Google Scholar
  37. 37.
    Dixon JL, Smalley MG (1981) Jehovah’s Witnesses. The surgical/ethical challenge. JAMA 246(21):2471–2472CrossRefPubMedGoogle Scholar
  38. 38.
    Bourantas KL, Xenakis TA, Hatzimichael EC, Kontogeorgakos V, Beris AE (2000) Peri-operative use of recombinant human erythropoietin in Jehovah’s Witnesses. Haematologica 85(4):444–445PubMedGoogle Scholar
  39. 39.
    Levy O, Martinowitz U, Oran A, Tauber C, Horoszowski H (1999) The use of fibrin tissue adhesive to reduce blood loss and the need for blood transfusion after total knee arthroplasty. A prospective, randomized, multicenter study. J Bone Jt Surg Am 81(11):1580–1588Google Scholar
  40. 40.
    Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A (1996) Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet 347(8997):289–292CrossRefPubMedGoogle Scholar
  41. 41.
    Klatsky AL, Armstrong MA, Poggi J (2000) Risk of pulmonary embolism and/or deep venous thrombosis in Asian-Americans. Am J Cardiol 85(11):1334–1337. doi: 10.1016/S0002-9149(00)00766-9 CrossRefPubMedGoogle Scholar
  42. 42.
    White RH, Zhou H, Gage BF (2004) Effect of age on the incidence of venous thromboembolism after major surgery. J Thromb Haemost JTH 2(8):1327–1333. doi: 10.1046/j.1538-7836.2004.00848.x CrossRefPubMedGoogle Scholar
  43. 43.
    White RH, Zhou H, Murin S, Harvey D (2005) Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse population in California in 1996. Thromb Haemost 93(2):298–305. doi: 10.1267/THRO05020298 PubMedGoogle Scholar
  44. 44.
    Kang BJ, Lee YK, Kim HJ, Ha YC, Koo KH (2011) Deep venous thrombosis and pulmonary embolism are uncommon in East Asian patients after total hip arthroplasty. Clin Orthop Relat Res 469(12):3423–3428. doi: 10.1007/s11999-011-1979-7 CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Zhang J, Chen Z, Zheng J, Breusch SJ, Tian J (2015) Risk factors for venous thromboembolism after total hip and total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 135(6):759–772. doi: 10.1007/s00402-015-2208-8 CrossRefPubMedGoogle Scholar
  46. 46.
    Danninger T, Stundner O, Ma Y, Bae JJ, Memtsoudis SG (2013) The impact of hypotensive epidural anesthesia on distal and proximal tissue perfusion in patients undergoing total hip arthroplasty. J Anesth Clin Res 4(11):366. doi: 10.4172/2155-6148.1000366 CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Westrich GH, Farrell C, Bono JV, Ranawat CS, Salvati EA, Sculco TP (1999) The incidence of venous thromboembolism after total hip arthroplasty: a specific hypotensive epidural anesthesia protocol. J Arthroplast 14(4):456–463CrossRefGoogle Scholar
  48. 48.
    Park MS, Kim SJ, Chung CY, Choi IH, Lee SH, Lee KM (2010) Statistical consideration for bilateral cases in orthopaedic research. J Bone Jt Surg Am 92(8):1732–1737. doi: 10.2106/JBJS.I.00724 CrossRefGoogle Scholar
  49. 49.
    Janssens M, Joris J, David JL, Lemaire R, Lamy M (1994) High-dose aprotinin reduces blood loss in patients undergoing total hip replacement surgery. Anesthesiology 80(1):23–29CrossRefPubMedGoogle Scholar
  50. 50.
    Konishi A, Kikuchi A (1996) Advertisement of bloodless medicine: the role of the department of anesthesiology. Autotransfusion 9:17–19Google Scholar
  51. 51.
    Morais S, Ortega-Andreu M, Rodriguez-Merchan EC, Padilla-Eguiluz NG, Perez-Chrzanowska H, Figueredo-Zalve R, Gomez-Barrena E (2014) Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach. Int Orthop 38(2):347–354. doi: 10.1007/s00264-013-2188-7 CrossRefPubMedGoogle Scholar
  52. 52.
    Horstmann WG, Swierstra MJ, Ohanis D, Rolink R, Kollen BJ, Verheyen CC (2014) Favourable results of a new intraoperative and postoperative filtered autologous blood re-transfusion system in total hip arthroplasty: a randomised controlled trial. Int Orthop 38(1):13–18. doi: 10.1007/s00264-013-2084-1 CrossRefPubMedGoogle Scholar
  53. 53.
    Harwin SF, Pivec R, Naziri Q, Issa K, Mont MA (2014) Is total hip arthroplasty a successful and safe procedure in Jehovah’s Witnesses? Mean 5-year results. Hip Int 24(1):69–76. doi: 10.5301/hipint.5000106 CrossRefPubMedGoogle Scholar
  54. 54.
    Issa K, Banerjee S, Rifai A, Kapadia BH, Harwin SF, McInerney VK, Mont MA (2013) Blood management strategies in primary and revision total knee arthroplasty for Jehovah’s Witness patients. J Knee Surg 26(6):401–404. doi: 10.1055/s-0033-1353994 CrossRefPubMedGoogle Scholar
  55. 55.
    Harwin SF, Issa K, Naziri Q, Pivec R, Johnson AJ, Mont MA (2013) Excellent results of revision TKA in Jehovah’s Witness patients. J Knee Surg 26(3):151–154. doi: 10.1055/s-0032-1324812 CrossRefPubMedGoogle Scholar
  56. 56.
    Harwin SF, Issa K, Naziri Q, Johnson AJ, Mont MA (2013) Results of primary total knee arthroplasty in Jehovah’s Witness patients. J Arthroplasty 28(1):49–55. doi: 10.1016/j.arth.2012.05.021 CrossRefPubMedGoogle Scholar
  57. 57.
    Bernasek T, Mangar D, Omar HR, Lyons S, Karlnoski RA, Chen R, Baumgarten A, Sprenker CJ, Camporesi EM (2013) Bloodless surgery by a regional intraarterial tourniquet during primary and revision THA. Orthopedics 36(12):e1527–e1533CrossRefPubMedGoogle Scholar
  58. 58.
    Harwin SF, Pivec R, Johnson AJ, Naziri Q, Mont MA (2012) Revision total hip arthroplasty in Jehovah’s Witnesses. Orthopedics 35(8):e1145–e1151. doi: 10.3928/01477447-20120725-11 CrossRefPubMedGoogle Scholar
  59. 59.
    Barsoum WK, Klika AK, Murray TG, Higuera C, Lee HH, Krebs VE (2011) Prospective randomized evaluation of the need for blood transfusion during primary total hip arthroplasty with use of a bipolar sealer. J Bone Jt Surg Am 93(6):513–518. doi: 10.2106/JBJS.J.00036 CrossRefGoogle Scholar
  60. 60.
    Rosenberg AG (2007) Reducing blood loss in total joint surgery with a saline-coupled bipolar sealing technology. J Arthroplast 22(4 Suppl 1):82–85. doi: 10.1016/j.arth.2007.02.018 CrossRefGoogle Scholar
  61. 61.
    de Castro Araujo BL (2013) Use of perioperative erythropoietin without pharmacologic thrombosis prophylaxis. Orthopedics 36(2):89. doi: 10.3928/01477447-20130122-11 CrossRefPubMedGoogle Scholar
  62. 62.
    Moonen AF, Thomassen BJ, Knoors NT, van Os JJ, Verburg AD, Pilot P (2008) Pre-operative injections of epoetin-alpha versus post-operative retransfusion of autologous shed blood in total hip and knee replacement: a prospective randomised clinical trial. J Bone Jt Surg Br 90(8):1079–1083. doi: 10.1302/0301-620X.90B8.20595 CrossRefGoogle Scholar
  63. 63.
    Ng T, Marx G, Littlewood T, Macdougall I (2003) Recombinant erythropoietin in clinical practice. Postgrad Med J 79(933):367–376CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Silva M, Grillot D, Benito A, Richard C, Nunez G, Fernandez-Luna JL (1996) Erythropoietin can promote erythroid progenitor survival by repressing apoptosis through Bcl-XL and Bcl-2. Blood 88(5):1576–1582PubMedGoogle Scholar
  65. 65.
    Huraib S, Abu-Aisha H, Al-Momen A, Al-Wakeel J, Memon N, Al-Tuwaijri A (1997) Effect of recombinant human erythropoietin on lymphocyte phenotyping and phagocyte activity in hemodialysis patients. Am J Kidney Dis 29(6):866–870CrossRefPubMedGoogle Scholar
  66. 66.
    Tilbrook PA, Klinken SP (1999) The erythropoietin receptor. Int J Biochem Cell Biol 31(10):1001–1005CrossRefPubMedGoogle Scholar
  67. 67.
    Weber EW, Slappendel R, Hemon Y, Mahler S, Dalen T, Rouwet E, van Os J, Vosmaer A, van der Ark P (2005) Effects of epoetin alfa on blood transfusions and postoperative recovery in orthopaedic surgery: the European Epoetin Alfa Surgery Trial (EEST). Eur J Anaesthesiol 22(4):249–257CrossRefPubMedGoogle Scholar
  68. 68.
    Sutton PM, Cresswell T, Livesey JP, Speed K, Bagga T (2004) Treatment of anaemia after joint replacement. A double-blind, randomised, controlled trial of ferrous sulphate versus placebo. J Bone Jt Surg Br 86(1):31–33Google Scholar
  69. 69.
    Munoz M, Gomez-Ramirez S, Martin-Montanez E, Naveira E, Seara J, Pavia J (2014) Cost of post-operative intravenous iron therapy in total lower limb arthroplasty: a retrospective, matched cohort study. Blood Transfus (Trasfusione del sangue) 12(1):40–49. doi: 10.2450/2013.0088-13 Google Scholar
  70. 70.
    Munoz M, Gomez-Ramirez S, Cuenca J, Garcia-Erce JA, Iglesias-Aparicio D, Haman-Alcober S, Ariza D, Naveira E (2014) Very-short-term perioperative intravenous iron administration and postoperative outcome in major orthopedic surgery: a pooled analysis of observational data from 2547 patients. Transfusion 54(2):289–299. doi: 10.1111/trf.12195 PubMedGoogle Scholar
  71. 71.
    Kapadia BH, Banerjee S, Issa K, McElroy MJ, Harwin SF, Mont MA (2013) Preoperative blood management strategies for total knee arthroplasty. J Knee Surg 26(6):373–377. doi: 10.1055/s-0033-1357492 CrossRefPubMedGoogle Scholar
  72. 72.
    Enko D, Wallner F, von-Goedecke A, Hirschmugl C, Auersperg V, Halwachs-Baumann G (2013) The impact of an algorithm-guided management of preoperative anemia in perioperative hemoglobin level and transfusion of major orthopedic surgery patients. Anemia 2013:641876. doi: 10.1155/2013/641876 CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Munoz M, Naveira E, Seara J, Cordero J (2012) Effects of postoperative intravenous iron on transfusion requirements after lower limb arthroplasty. Br J Anaesth 108(3):532–534. doi: 10.1093/bja/aes012 CrossRefPubMedGoogle Scholar
  74. 74.
    Yang Y, Li H, Li B, Wang Y, Jiang S, Jiang L (2011) Efficacy and safety of iron supplementation for the elderly patients undergoing hip or knee surgery: a meta-analysis of randomized controlled trials. J Surg Res 171(2):e201–e207. doi: 10.1016/j.jss.2011.08.025 CrossRefPubMedGoogle Scholar
  75. 75.
    Na HS, Shin SY, Hwang JY, Jeon YT, Kim CS, Do SH (2011) Effects of intravenous iron combined with low-dose recombinant human erythropoietin on transfusion requirements in iron-deficient patients undergoing bilateral total knee replacement arthroplasty. Transfusion 51(1):118–124. doi: 10.1111/j.1537-2995.2010.02783.x CrossRefPubMedGoogle Scholar
  76. 76.
    Cuenca J, Garcia-Erce JA, Martinez F, Perez-Serrano L, Herrera A, Munoz M (2006) Perioperative intravenous iron, with or without erythropoietin, plus restrictive transfusion protocol reduce the need for allogeneic blood after knee replacement surgery. Transfusion 46(7):1112–1119. doi: 10.1111/j.1537-2995.2006.00859.x CrossRefPubMedGoogle Scholar
  77. 77.
    Cuenca J, Garcia-Erce JA, Martinez AA, Solano VM, Molina J, Munoz M (2005) Role of parenteral iron in the management of anaemia in the elderly patient undergoing displaced subcapital hip fracture repair: preliminary data. Arch Orthop Trauma Surg 125(5):342–347. doi: 10.1007/s00402-005-0809-3 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgerySoonchunhyang University Hospital SeoulSeoulSouth Korea
  2. 2.Department of Orthopaedic SurgeryChung-Ang University College of MedicineSeoulSouth Korea
  3. 3.Department of Orthopaedic SurgerySeoul National University Bundang HospitalSeongnamSouth Korea

Personalised recommendations