Safety of retransfusion of filtered shed blood in 1819 patients after total hip or knee arthroplasty

Abstract

SUMMARY Autologous retransfusion of filtered drained blood is widely used after total hip (THA) and knee arthroplasty (TKA) in many countries. Despite its wide use, prospective studies on clinical side effects with a substantial number of patients have not been published. In this prospective clinical trial, 1819 consecutive patients in 38 hospitals were retransfused using a low‐suction drainage autologous blood transfusion system, after THA (n = 995) or TKA (n = 824). The occurrence of adverse events during retransfusion of the filtered shed blood was studied. An average of 460 mL of drained blood (THA, 374 mL; TKA, 563 mL) was retransfused within 6 hours postoperatively. The frequency of serious adverse events was 0.1%, which concerned two patients: one had a short asystole during reinfusion that responded quickly to medication; and the other with a history of deep vein thrombosis had pulmonary embolism. By way of non‐serious adverse events, febrile reactions (fever, shivering) were observed in 3.1% of the patients during retransfusion. Clot formation was observed in the drained blood in six (0.3%) patients; therefore, retransfusion was not carried out. These minor adverse events were seen more often after TKA (5.8%) than after THA (1.5%). Nine (0.5%) patients were retransfused with volumes above 1500 mL (average 1657, range 1550–1900), without adverse events. Additional allogenic blood transfusions were required by 18% of the THA and 9% of the TKA patients. In this study, few adverse events were detected during retransfusion. The frequency of serious (0.1%) and minor (3.5%) adverse events was similar to other smaller clinical studies. Based on the low incidence of side effects in this large cohort of orthopedic patients, postoperative cell salvage with such a retransfusion system is considered to be safe.

Unwashed blood: is widespread use justified? A review of current knowledge

“…Besides these reported complications, there are numerous clinical studies that seem to support the notion that reinfusion of unwashed PSB is safe. In an evaluation of 1819 patients receiving unwashed PSB after elective lower limb arthroplasty in 38 Dutch hospitals, the frequency of serious adverse events (0.1%; one patient had a brief asystole during reinfusion which responded quickly to medication; and the other, with a history of deep vein thrombosis, had pulmonary embolism) and minor adverse events (3.5%, mostly fever or shivering) was similar to that in other smaller clinical studies 32 . Nine (0.5%) patients were retransfused with volumes above 1500 mL, without adverse events.…”

Transfusion Reduction in Orthopedic Surgery

“…Some studies investigating the general reactions of the body to retransfused blood found no transfusion reactions nor fevers when transfused with unwashed, filtered autologous blood. Some chills were found, though (up to 3,1%), with use of a non-leucocyte depleting filter (Athanasoulias et al, 2007;Horstmann et al, 2010). Duchow et al found high levels of factor XIIa, thrombin and fibrin generation markers, and markers of fibrinolysis in the shed blood.…”

Autotransfusion: Therapeutic Principles, Efficacy and Risks

“…Most research has been published investigating the safety of reinfusion of unwashed drain-blood. A Dutch study of 1819 patients undergoing orthopaedic surgery showed adverse reactions in 3.6% of cases (Horstmann et al 2009). Most reactions were mild, such as fever (> 38,5 0 C) and shivering.…”