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Does Single Use of an Autologous Transfusion System in TKA Reduce the Need for Allogenic Blood?: A Prospective Randomized Trial

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

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.

Questions/purposes

We therefore asked whether one such autologous transfusion system for WSB can reduce the requirements for postoperative ABT.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

We thank R. Germann Assoc. Prof. MD and G. Pfanner MD, Department of Anesthesia, University Teaching Hospital Feldkirch, Medical University of Innsbruck, Feldkirch, Austria, and A. von Strempel Assoc. Prof., MD, DEng, Department of Orthopaedic Surgery, University Teaching Hospital, Medical University of Innsbruck, Feldkirch, Austria, for scientific assistance and editorial review.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Academic Teaching Hospital, Medical University of Innsbruck, Carinagasse 47, A-6800, Feldkirch, Austria

    Johannes Cip MD, Mark Widemschek MD & Arno Martin MD, MSc

  2. Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria

    Thomas Benesch PhD

  3. Sport Orthopaedic Clinic Bern, Münsingen, Switzerland

    Roman Waibel MD

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  1. Johannes Cip MD
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  2. Mark Widemschek MD
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  3. Thomas Benesch PhD
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  4. Roman Waibel MD
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  5. Arno Martin MD, MSc
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Corresponding author

Correspondence to Arno Martin MD, MSc.

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

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Department of Orthopaedic Surgery, Academic Teaching Hospital, Medical University of Innsbruck, Feldkirch, Austria.

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Cip, J., Widemschek, M., Benesch, T. et al. Does Single Use of an Autologous Transfusion System in TKA Reduce the Need for Allogenic Blood?: A Prospective Randomized Trial. Clin Orthop Relat Res 471, 1319–1325 (2013). https://doi.org/10.1007/s11999-012-2729-1

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