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

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

Effectiveness of an autologous transfusion system following cemented and non-cemented revisions of total hip arthroplasty

“…Cip et al [36] performed a prospective randomised controlled study with 151 patients treated with TKA and did not find a reduction of the rate of postoperative ABTs for patients receiving WSB. Amin and colleagues presented similar results in their analysis of TKA patients [37].…”

“…Although the use of retransfusion systems in orthopaedic surgery seems to have increased [15,[33][34][35] in recent years, it remains unclear whether there is a benefit in obviating the need for ABT [36] especially in revision procedures.…”

Pre-operative autologous blood donation versus no blood donation in total knee arthroplasty: a prospective randomised trial

“…Also, there was no significant difference between groups regarding the amounts of post-operatively collected and returned blood. According to Woolson and Wall [7] post-operative autotransfusion is equally effective as PABD in the prevention of risks associated with the use of allogeneic transfusion after TKA, while Cip et al [18] in their prospective, randomised study showed that postoperative autotransfusion systems do not reduce the percentage of post-operative allogeneic blood transfusions after TKA. Statistically significant differences among the three groups were observed for preoperative Hb (p =0.002), reticulocyte count (p =0.026) and the level of iron in the blood (p =0.022).…”

“…NCSS, LLC. Kaysville, UT, USA] software package using data on post-operative Hb concentration after TKA from Cip et al [18]. The null hypothesis was defined as equivalence in Hb concentration on post-operative day two between subjects without pre-operative blood donation and subjects who gave blood 72 hours prior to operation.…”

“…The null hypothesis was defined as equivalence in Hb concentration on post-operative day two between subjects without pre-operative blood donation and subjects who gave blood 72 hours prior to operation. Equivalence was defined as a difference in Hb levels of ± 10 g/l around the hypothesised mean value of 100 g/l, with standard deviation of Hb levels of 10 g/l [18]. With statistical power (β) set to 0.80 and type I error (α) to 0.05, the final sample size was 18 subjects per group.…”