Adjusted transfusion triggers improve transfusion practice in orthopaedic surgery

Abstract

Although blood transfusion has never been safer, there remains concern about adverse effects. We designed guidelines, the 6-8-10-Flexinorm, based on the conditions which are relevant to the decision to transfuse. To evaluate these new guidelines, we performed a case-control study in patients undergoing elective primary total hip replacement. The study consisted of two parts. In the first part, physicians were strongly encouraged to use the new guidelines; in the second part, only registration took place. During the first and second part of the study, the use of packed red cells (PRC) in Hospital A (study hospital) decreased from 1.1 +/- 1.5 to 0.6 +/- 1.2 and 0.3 +/- 0.9 units, whereas in Hospital B (control), the use of PRC remained unchanged (1 +/- 1.5, 1 +/- 1.7 and 1 +/- 2 units). In the prestudy groups, 43% of the patients in Hospital A were transfused compared to 45% in Hospital B. In the first and second part of the study, 27%, respectively, 14% of the patients in Hospital A were transfused compared to 40% in both periods in Hospital B. The new guidelines lead to a reduction in the use of allogeneic blood and a decrease in the number of patients transfused.

Predicting transfusion in shoulder arthroplasty

“…The difference between a type and crossmatch and a type and screen has both financial and resource management application. 3,14,18 Crossmatched blood is taken from the general blood bank and set aside for that specific patient for 48 hours, making it unavailable for any other patient. Common practice is to crossmatch blood that is near its expiration.…”

“…Ordering blood typing on carefully screened patients can help to reduce costs and avoid the mismanagement of blood products to allow for their optimal distribution. 3,14,16,18 We recommend checking hemoglobin levels within 30 days of a planned arthroplasty. A patient who falls below the normal range should undergo additional testing and appropriate consultation to determine the etiology of anemia.…”

“…Using evidence-based transfusion guidelines, several authors 1,3 have significantly lowered transfusion rates in elective primary total knee and hip arthroplasties. Despite the lack of predefined transfusion criteria that a prospective study might incorporate, we believe our transfusion policies are based on sound principles that were neither too aggressive nor conservative.…”

“…Much has been written about blood transfusions in orthopedic surgery, 2,3,6,9,10,13,15,17,20,21 but little has been published looking specifically at the subgroup of shoulder arthroplasty. Recent data indicate a nearly 7-fold increase in the number of shoulder arthroplasty procedures performed during the last 3 decades.…”

Proinflammatory, immunomodulating, and prothrombotic properties of anemia and red blood cell transfusions

“…The development of hospital-based transfusion services represents an effective means to track blood product utilization, develop institution-wide guidelines for transfusion and assess physician practices, particularly changes in response to behavorial interventions [51] (either on-site decision algorithms [52] or computerized order-entry parameters).…”