Skip to main content
SpringerLink
Log in

Allogeneic Transfusion after Predonation of Blood for Elective Spine Surgery

  • Original Article
  • Published:
Clinical Orthopaedics and Related Research

Abstract

The literature suggests preoperative autologous blood donation in total joint arthroplasty is associated with increased overall transfusion rates compared with nondonation and is not cost-effective for all patients. We asked whether the amount of intraoperative blood loss and blood replacement differs between autologous donors and nondonors in elective spine surgery and whether the rates of allogeneic blood transfusions differ between the two groups; we then determined the cost of wasted predonated units. We retrospectively reviewed 676 patients who underwent elective lumbar spine surgery and compared relevant data to that in a matched cohort of 51 patients who predonated blood and 51 patients who received only cell-saver blood and underwent instrumented spinal fusion. Patients who predonated blood had similar blood loss as patients who did not predonate, but they had more blood replacement (1391 cc compared with 410 cc). Patients who predonated blood also had a lower preoperative hemoglobin level and wasted a half unit of blood on average. There was no major difference in allogeneic blood transfusion rates between the two groups. Our data suggest for short, instrumented lumbar fusion surgeries in patients with a normal coagulation profile, preoperative blood donation is not beneficial.

Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bennett J, Haynes S, Torella F, Grainger H, McCollum C. Acute normovolemic hemodilution in moderate blood loss surgery: a randomized controlled trial. Transfusion. 2006;46:1097–1103.

    Article  PubMed  Google Scholar 

  2. Berenholtz SM, Pronovost PJ, Mullany D, Garrett E, Ness PM, Dorman T, Klag MJ. Predictors of transfusion for spinal surgery in Maryland, 1997 to 2000. Transfusion. 2002;42:183–189.

    Article  PubMed  Google Scholar 

  3. Bern MM, Bierbaum BE, Katz JN, Losina E. Autologous blood donation and subsequent blood use in patients undergoing total knee arthroplasty. Transfus Med. 2006;16:313–319.

    Article  PubMed  CAS  Google Scholar 

  4. 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;81:2–10.

    PubMed  CAS  Google Scholar 

  5. 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;84:1299–1304.

    PubMed  Google Scholar 

  6. Bridgens JP, Evans CR, Dobson PM, Hamer AJ. Intraoperative red blood-cell salvage in revision hip surgery: a case-matched study. J Bone Joint Surg Am. 2007;89:270–275.

    Article  PubMed  CAS  Google Scholar 

  7. Cha CW, Deible C, Muzzonigro T, Lopez-Plaza I, Vogt M, Kang JD. Allogeneic transfusion requirements after autologous donations in posterior lumbar surgeries. Spine. 2002;27:99–104.

    Article  PubMed  Google Scholar 

  8. Chandra A, Smith DR, Nanda A. Autotransfusion by cell saver technique in surgery of lumbar and thoracic spinal fusion with instrumentation. J Neurosurg. 2002;96(3 suppl 3):298–303.

    Google Scholar 

  9. Copley LAB, Richards BS, Safavi FZ, Newton PO. Hemodilution as a method to reduce transfusion requirements in adolescent spine fusion surgery. Spine. 1999;24:219–222; discussion 223–224.

    Article  PubMed  CAS  Google Scholar 

  10. Cregan P, Donegan E, Gotelli G. Hemolytic transfusion reaction following transfusion of frozen and washed autologous red cells. Transfusion. 1991;31:172–175.

    Article  PubMed  CAS  Google Scholar 

  11. Epstein NE, Peller A, Korsh J, DeCrosta D, Boutros A, Schmigelski C, Greco J. Impact of intraoperative normovolemic hemodilution on transfusion requirements for 68 patients undergoing lumbar laminectomies with instrumented posterolateral fusion. Spine. 2006;31:2227–2230; discussion 2231.

    Article  PubMed  Google Scholar 

  12. Eroglu A, Uzunlar H, Erciyes N. Comparison of hypotensive epidural anesthesia and hypotensive total intravenous anesthesia on intraoperative blood loss during total hip replacement. J Clin Anesth. 2005;17:420–425.

    Article  PubMed  CAS  Google Scholar 

  13. Forgie MA, Wells PS, Laupacis A, Fergusson D. 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. 1998;158:610–616.

    Article  PubMed  CAS  Google Scholar 

  14. Goulet JA, Bray TJ, Timmerman LA, Benson DR, Bargar WL. Intraoperative autologous transfusion in orthopaedic patients. J Bone Joint Surg Am. 1989;71:3–8.

    PubMed  CAS  Google Scholar 

  15. Grosflam JM, Wright EA, Cleary PD, Katz JN. Predictors of blood loss during total hip replacement surgery. Arthritis Care Res. 1995;8:167–173.

    Article  PubMed  CAS  Google Scholar 

  16. Guay J, Haig M, Lortie L, Guertin MC, Poitras B. Predicting blood loss in surgery for idiopathic scoliosis. Can J Anaesth. 1994;41:775–781.

    Article  PubMed  CAS  Google Scholar 

  17. 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;82:89–100.

    PubMed  CAS  Google Scholar 

  18. Healy WL, Pfeifer BA, Kurtz SR, Johnson C, Johnson W, Johnston R, Sanders D, Karpman R, Hallack GN, Valeri CR. Evaluation of autologous shed blood for autotransfusion after orthopaedic surgery. Clin Orthop Relat Res. 1994;299:53–59.

    PubMed  Google Scholar 

  19. Johnson RG, Murphy M, Miller M. Fusions and transfusions: an analysis of blood loss and autologous replacement during lumbar fusions. Spine. 1989;14:358–362.

    Article  PubMed  CAS  Google Scholar 

  20. Keating EM, Meding JB, Faris PM, Ritter MA. Predictors of transfusion risk in elective knee surgery. Clin Orthop Relat Res. 1998;357:50–59.

    Article  PubMed  Google Scholar 

  21. Meiser A, Casagranda O, Skipka G, Laubenthal H. [Quantification of blood loss: how precise is visual estimation and what does its accuracy depend on?][in German]. Anaesthesist. 2001;50:13–20.

    Article  PubMed  CAS  Google Scholar 

  22. Moran MM, Kroon D, Tredwell SJ, Wadsworth LD. The role of autologous blood transfusion in adolescents undergoing spinal surgery. Spine. 1995;20:532–536.

    Article  PubMed  CAS  Google Scholar 

  23. Murray D. Acute normovolemic hemodilution. Eur Spine J. 2004;13(suppl 1):S72–75.

    Article  PubMed  Google Scholar 

  24. Woolson ST, Wall WW. Autologous blood transfusion after total knee arthroplasty: a randomized prospective study comparing predonated and postoperative salvage blood. J Arthoplasty. 2003;18:243–249.

    Article  Google Scholar 

  25. Zheng F, Cammisa FP Jr, Sandhu HS, Girardi FP, Khan SN. Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation. Spine. 2002;27:818–824.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, University of Miami Miller School of Medicine, PO Box 016960 (R-2), Miami, FL, 33101, USA

    Kathleen F. Brookfield PhD, MPH, Mark D. Brown MD, PhD, Steven M. Henriques BA, Frank A. Buttacavoli BA & Alison P. Seitz

Authors
  1. Kathleen F. Brookfield PhD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark D. Brown MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Steven M. Henriques BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Frank A. Buttacavoli BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alison P. Seitz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathleen F. Brookfield PhD, MPH.

Additional information

Each author certifies that he or she has no 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.

Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

About this article

Cite this article

Brookfield, K.F., Brown, M.D., Henriques, S.M. et al. Allogeneic Transfusion after Predonation of Blood for Elective Spine Surgery. Clin Orthop Relat Res 466, 1949–1953 (2008). https://doi.org/10.1007/s11999-008-0306-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-008-0306-4

Keywords

Search

Navigation