Effectiveness of autologous transfusion system in primary total hip and knee arthroplasty

Abstract

BACKGROUND: Autologous transfusion has become a cost-efficient and useful option in the treatment of patients with high blood loss following major orthopaedic surgery. However, the effectiveness of autologous transfusion in total joint replacement remains controversial. OBJECTIVE: The current study analyzed the efficacy of autologous transfusion with washed shed blood (WSB) in primary total knee and total hip arthroplasty (TKA, THA). METHODS: Between January 2011 and December 2011, patients being treated with a primary TKA (n = 162) and/or THA (n = 227) and who met the inclusion criteria were recruited to the study in consecutive fashion. RESULTS: The patient age, BMI and ASA scores showed no statistically significant correlation to the degree of blood loss, quantity of autotransfusion necessary or Hb differential in TKA patients. The use of an autologous transfusion system in TKA and THA is not correlated statistically to a reduction in the amount of allogenic or autologous transfusion. CONCLUSIONS: The use of the autotransfusion system does not correlate significantly with the amount of allogenic transfusion in TKA and THA in the current authors' patient cohort. Age, BMI and ASA score appeared not to exert significant influence on the total amount of autotransfusion or Hb difference.

A secure blood-saving protocol for Jehovah’s Witnesses in primary total hip replacement

“…Gargaro and Walls[ 14 ] compared the ABT rates among patients who underwent THR with (n=32) and without (n=32) intraoperative use of cell saver. In line with Schneider et al,[ 9 ] they did not find a significant difference between these patient groups. [ 14 ] In contrast, Guerra and Cuckler[ 11 ] stated that the use of cell saver during primary THR surgeries led to a 40% decrease in the rate of ABTs.…”

“…[6] Therefore, efforts spent to date to develop strategies for reducing ABT rates during or after THR are justified. [5,[7][8][9][10][11][12][13][14][15] Several preoperative, intraoperative, and postoperative blood management protocols have been proposed. Preoperative preventions include hemoglobin (Hgb) optimization in anemic patients using erythropoietin (EPO) injection and intravenous iron replacement therapy.…”

Does tourniquet use decrease blood loss following primary total knee arthroplasty in Jehovah’s Witness patients?

“…There are contradictory findings in the literature regarding the use of cell salvage in TKA. Schneider et al[ 19 ] reported that cell salvage had no beneficial effect on the rate of allogeneic blood transfusion. In contrast, Park et al[ 20 ] showed a significant reduction in blood transfusion in their study.…”

Autologous transfusions for elective surgery - from existing approaches to upcoming challenges

“…Concerning AT, patient's blood can be collected using different strategies among which the most frequently applied are the following ones: 1) preoperative autologous collection/donation (PAD); 2) acute normovolemic hemodilution (ANH); and 3) perioperative blood recovery/salvage (PBR). In addition, the scheme of PBR includes: a) intraoperative blood collection/salvage (IBC) from the surgical field, and b) postoperative blood collection/drainage (PBC) by aspiration 1,[14][15][16][17][18][19][20][21][22] . Independently or combined, these AT-strategies proved to reduce the needs for allogeneic blood in elective surgery.…”

“…Opinions regarding efficiency of PBC in orthopedic surgery are not unanimous and the following should be taken into consideration: 1) prospect studies to illustrate the benefits of transfusion of "saved" blood; b) make analyses of risks of transfusion of unprocessed blood, taking into special consideration possible contamination of blood with bacteria or chemical agents (e.g. metylmetakrylat) and 3) analysis of cost vs benefit aspects 6,[14][15][16][17][18][19][20][21][22] .…”