Do we really need to routinely crossmatch blood before primary total knee or hip arthroplasty?

Mundy, G.M.; Hardiment, Kate; Revill, John; Birtwistle, S.J.; Power, Richard

doi:10.1080/00016470410001439

Cited by 9 publications

(9 citation statements)

References 2 publications

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“…15 In addition, we routinely stop the administration of NSAIDS five days before surgery since they may increase peri-operative blood loss and transfusion requirements. 16 We have reported a transfusion rate of less than 20% for all patients who have undergone lower-limb arthroplasty in our hospital. 17 The remaining asymptomatic patients had previously been treated with ferrous sulphate (200 mg three times daily) which is a recognised oral treatment for iron-deficiency anaemia.…”

Section: Discussionmentioning

confidence: 76%

“…Between June 11 and March 31, 2003, 334 patients were screened for inclusion in the study of whom 207 were ineligible for the following reasons: low haemoglobin (46), low platelet count (6), raised CRP (28), a past history of cancer (16), abnormal renal function (15), low serum ferritin (16), current administration of iron supplements (21), and unwillingness to participate (84). Some were ineligible Table I.…”

Section: Resultsmentioning

confidence: 99%

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The effect of iron supplementation on the level of haemoglobin after lower limb arthroplasty

Mundy

Birtwistle

Power

2005

The Journal of Bone and Joint Surgery. British volume

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We randomised 120 patients who were undergoing either primary total hip or knee arthroplasty to receive either ferrous sulphate or a placebo for three weeks after surgery. The level of haemoglobin and absolute reticulocyte count were measured at one and five days, and three and six weeks after operation. Ninety-nine patients (ferrous sulphate 50, placebo 49) completed the study. The two groups differed only in the treatment administered. Recovery of level of haemoglobin was similar at five days and three weeks and returned to 85% of the pre-operative level, irrespective of the treatment group. A small, albeit greater recovery in the level of haemoglobin was identified at six weeks in the ferrous sulphate group in both men (ferrous sulphate 5%, placebo 1.5%) and women (ferrous sulphate 6%, placebo 3%). The clinical significance of this is questionable and may be outweighed by the high incidence of reported side effects of oral iron and the cost of the medication. Administration of iron supplements after elective total hip or total knee arthroplasty does not appear to be worthwhile.

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Section: Discussionmentioning

confidence: 76%

Section: Resultsmentioning

confidence: 99%

The effect of iron supplementation on the level of haemoglobin after lower limb arthroplasty

Mundy

Birtwistle

Power

2005

The Journal of Bone and Joint Surgery. British volume

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“…The proportion of female patients in TKA studies, however, is usually high and it varies between 70 to 90 percent, as in our analyzed studies. Transfusion use in TKA is also widely variable depending on the centers, and it has been reported a transfusion rate between 4 to 72 percent 22‐24 . Six (67%) of nine RCTs reported a treatment effect favoring the use of TA for reducing blood transfusion in patients undergoing TKA, whereas the remainding three (33%) studies showed no advantage to the administration of TA.…”

Section: Discussionmentioning

confidence: 99%

Tranexamic acid reduces allogeneic red cell transfusions in patients undergoing total knee arthroplasty: results of a meta‐analysis of randomized controlled trials

2005

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“…This leads to increased waste, larger inventories, and increased departmental costs. 4,9,12,13 Other variables must be considered to effectively assess the need for crossmatching units to a patient and include: preoperative hemoglobin level, predicted blood loss, patient blood volume and likelihood of transfusion 5,6,9,12,13 These variables should all be used in conjunction to evaluate patient needs.…”

Section: Discussionmentioning

confidence: 99%

“…This is a widely accepted method to monitor product use, a 2.0 benchmark is generally considered appropriate. 8,13,14 Apparent in a United Kingdom study, Mundy et al 9 concluded that 77% of total hip and 62% of total knee surgeries requested units which were never used.…”

Section: Introductionmentioning

confidence: 99%

Impacts of Updated Transfusion Guidelines on a Small Hospital Blood Bank in a Chicago Suburb

Frelitz

2016

Clin Lab Sci

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The purpose of this research was to identify effective means to utilize blood product resources within a hospital laboratory. A retrospective review of six years of blood utilization data (2010)(2011)(2012)(2013)(2014)(2015) was analyzed from Rush Oak Park Hospital, Oak Park, IL, a small hospital blood bank in a suburb of Chicago. Time-frames included: before electronic medical record (EMR) use: after EMR implementation and computerized provider order entry (CPOE) use: and following targeted physician education. Updated transfusion indications were implemented in time-frame three in an effort to reduce unnecessary crossmatch and transfusion orders, and improve patient safety. The mean number of crossmatched and transfused units decreased significantly from time-frame two to three: from 236±44 units crossmatched to 166±29 units (p <0.001) and 154±31 units to 99±18 units transfused (p<0.001). The blood type and antibody screen (T/S) samples increased significantly over the same period (p<0.03). Surgical and emergency room (ER) crossmatch to transfusion ratios (C:T) showed no significant change, while the other category (inpatient, outpatient, and Hematology/Oncology clinic) revealed a significant increase over time-frames two to three (p<0.001). The number of red blood cell (RBC) units transfused from 2013 to 2014 declined by 646 units, with an estimated cost savings of $129,200. Providing evidence-based guidelines with CPOE to reduce ordering and preparation of blood products is an area of opportunity to improve care and reduce costs. ABBREVIATIONS: EMR -electronic medical record; CPOE = computerized provider order entry; MSBOSmaximum surgical blood order schedule; T/S -blood type and antibody screen; ER -emergency room; C:Tcrossmatch to transfusion ratio; RBC -red blood cell; ANOVA -analysis of variance INDEX TERMS: Blood grouping/crossmatching, erythrocyte transfusion/utilization, cost-savings Clin Lab Sci 2016;29(1):16-20

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Do we really need to routinely crossmatch blood before primary total knee or hip arthroplasty?

Cited by 9 publications

References 2 publications

The effect of iron supplementation on the level of haemoglobin after lower limb arthroplasty

The effect of iron supplementation on the level of haemoglobin after lower limb arthroplasty

Tranexamic acid reduces allogeneic red cell transfusions in patients undergoing total knee arthroplasty: results of a meta‐analysis of randomized controlled trials

Impacts of Updated Transfusion Guidelines on a Small Hospital Blood Bank in a Chicago Suburb

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