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Nonanemic Patients Do Not Benefit from Autologous Blood Donation Before Total Hip Replacement

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HSS Journal


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.

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  1. 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):2–10

    CAS  Google Scholar 

  2. Biesma DH, Marx JJ, van de Wiel A (1994) Collection of autologous blood before elective hip replacement. A comparison of the results with the collection of two and four units. J. Bone Jt. Surg. Am. 76(10):1471–1475

    CAS  Google Scholar 

  3. Billote DB, Glisson SN, Green D, Wixson RL (2002) A prospective, randomized study of preoperative autologous donation for hip replacement surgery. J. Bone Jt. Surg. Am. 84-A(8):1299–1304

    Google Scholar 

  4. Bong MR, Patel V, Chang E, Issack PS, Hebert R, Di Cesare PE (2004) Risks associated with blood transfusion after total knee arthroplasty. J. Arthroplast. 19(3):281–287

    Article  Google Scholar 

  5. Couvret C, Laffon M, Baud A, Payen V, Burdin P, Fusciardi J (2004) A restrictive use of both autologous donation and recombinant human erythropoietin is an efficient policy for primary total hip or knee arthroplasty. Anesth. Analg. 99(1):262–271

    Article  CAS  PubMed  Google Scholar 

  6. 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

  7. Cushner FD, Lee GC, Scuderi GR, Arsht SJ, Scott WN (2006) Blood loss management in high-risk patients undergoing total knee arthroplasty: a comparison of two techniques. J. Knee Surg. 19(4):249–253

    PubMed  Google Scholar 

  8. Deutsch A, Spaulding J, Marcus RE (2006) Preoperative epoetin alfa vs autologous blood donation in primary total knee arthroplasty. J. Arthroplast. 21(5):628–635

    Article  Google Scholar 

  9. Etchason J, Petz L, Keeler E, Calhoun L, Kleinman S, Snider C, Fink A, Brook R (1995) The cost effectiveness of preoperative autologous blood donations. N. Engl. J. Med. 332(11):719–724

    Article  CAS  PubMed  Google Scholar 

  10. Faris PM, Ritter MA, Abels RI (1996) The effects of recombinant human erythropoietin on perioperative transfusion requirements in patients having a major orthopaedic operation. The American Erythropoietin Study Group. J. Bone Jt. Surg. Am. 78(1):62–72

    CAS  Google Scholar 

  11. Forgie MA, Wells PS, Laupacis A, Fergusson D (1998) Preoperative autologous donation decreases allogeneic 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. 158(6):610–616

    Article  CAS  PubMed  Google Scholar 

  12. Green WS, Toy P, Bozic KJ, Cost minimization analysis of preoperative erythropoietin vs autologous and allogeneic blood donation in total joint arthroplasty. J Arthroplast. 2009 (in press)

  13. 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

  14. Hatzidakis AM, Mendlick RM, McKillip T, Reddy RL, Garvin KL (2000) Preoperative autologous donation for total joint arthroplasty. An analysis of risk factors for allogenic transfusion. J. Bone Jt. Surg. Am. 82(1):89–100

    CAS  Google Scholar 

  15. Lee GC, Cushner FD (2007) The effects of preoperative autologous donations on perioperative blood levels. J. Knee Surg. 20(3):205–209

    PubMed  Google Scholar 

  16. Martinez V, Monsaingeon-Lion A, Cherif K, Judet T, Chauvin M, Fletcher D (2007) Transfusion strategy for primary knee and hip arthroplasty: impact of an algorithm to lower transfusion rates and hospital costs. Br. J. Anaesth. 99(6):794–800

    Article  CAS  PubMed  Google Scholar 

  17. Slappendel R, Dirksen R, Weber EW, van der Schaaf DB (2003) An algorithm to reduce allogenic red blood cell transfusions for major orthopedic surgery. Acta Orthop. Scand. 74(5):569–575

    Article  PubMed  Google Scholar 

  18. Walsh M, Preston C, Bong M, Patel V, Di Cesare PE (2007) Relative risk factors for requirement of blood transfusion after total hip arthroplasty. J. Arthroplast. 22(8):1162–1167

    Article  Google Scholar 

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Correspondence to Friedrich Boettner MD.

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Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participating in the study was obtained. Institutional Review Board Approval, IRB# 28103.

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Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

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Boettner, F., Altneu, E.I., Williams, B.A. et al. Nonanemic Patients Do Not Benefit from Autologous Blood Donation Before Total Hip Replacement. HSS Jrnl 6, 66–70 (2010).

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