A randomized trial on the efficacy of an autologous blood drainage and transfusion device in patients undergoing elective knee arthroplasty

Abstract

The purpose of the study reported here was the determination of the efficacy of a postoperative autologous blood drainage and transfusion device in reducing allogeneic red cell requirements in patients undergoing elective knee arthroplasty. The study was a randomized controlled trial with adult patients undergoing unilateral elective arthroplastic knee surgery. Patients underwent suction drainage, attached to an autologous blood drainage and transfusion device, or standard suction drainage. Allogeneic red cells were given according to strict transfusion guidelines based on blood loss and postoperative hemoglobin values. Outcome measures included the mean number of allogeneic red cell concentrates required and the number of patients in each group who required no transfusion. Patients assigned to standard suction drainage had a mean allogeneic red cell utilization of 1.2 units (SD 1.0), as compared to a mean of 0.4 units (SD 0.8) in the group undergoing drainage with the autologous blood drainage and transfusion device (p = 0.0007). The percentage of patients not requiring allogeneic red cells was significantly higher in the latter group (74.3% vs. 32.5%; p = 0.002). The postoperative drainage and transfusion device was efficacious in reducing the amount of allogeneic red cells required by patients undergoing knee arthroplasty, and its use resulted in a 42 percent reduction in the number of patients requiring allogeneic transfusion.

Soluble CD40 ligand accumulates in stored blood components, primes neutrophils through CD40, and is a potential cofactor in the development of transfusion-related acute lung injury

“…17 Moreover, though A-Plts are thought to be a purer platelet product than WB-Plts with respect to the increased rate of adverse events, sCD40L was increased in these components compared with WB-Plts and thus may have unexpected effects in the transfused host. 41,42 A recent report revealed that sCD40L is associated with adverse events in patients requiring platelet transfusion (in press). 43 Furthermore, sCD40L may have direct Figure 6.…”

Blood Transfusion in Knee Arthroplasty

“…Regarding the use of blood retrieval in total knee ( Dalen et al, 1996;Gannon et al, 1991;Groh et al, 1990;Handel et al, 2006;Heddle et al, 1992;Hendrych, 2006;Kristensen et al, 1992;Majkowski et al, 1991;Martin et al, 1992;Munoz et al, 2005a;Noain et al, 2005;Simpson et al, 1994;Strumper et al, 2004;Thomas et al, 2001;Wojan et al, 2005;Xenakis et al, 1997) and hip (Gannon et al, 1991;Kristensen et al, 1992) arthroplasty, it is considered to be useful as it decreases blood transfusion necessity, reaching a 48% decrease transfusion requirements. The use of postoperative retrieval in knee or hip primary surgery, analyzed from a costbenefit point of view, is a profitable procedure ( Dramis & Plewes, 2006;Jones et al, 2004;Thomas et al, 2001;Wojan et al, 2005).…”

Alternative Procedures for Reducing Allogeneic Blood Transfusion in Elective Orthopedic Surgery

“…Intraoperative cell salvage has been proven to be an effective method to avoid allogeneic blood transfusion [81]. Indirect autologous transfusion systems in orthopedic patients can decrease the need for allogeneic blood transfusions from 70% to 23% [43]. Due to high cost (Cell Saver® about $2400, Haemo- Another method for replacing shed blood includes reinfusion of postoperative drainage as a form of direct autologous transfusion (e.g., Bellovac ABT®, Astra Tech, Vienna, Austria).…”