Nonanemic Patients Do Not Benefit from Autologous Blood Donation Before Total Hip Replacement (original) (raw)
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International Orthopaedics, 2014
Purpose Pre-operative donation of autologous blood has been widely used in elective joint replacement procedures to avoid the risks of allogeneic blood transfusions. However, the high percentage of wasted autologous blood questions the general efficacy of pre-operative autologous blood donation (PABD) for all patients undergoing hip replacement. This study prospectively investigates the impact of a targeted pre-operative autologous blood donation protocol for anaemic patients on allogeneic and overall transfusion rates in 2,350 unilateral primary total hip arthroplasty procedures. Methods Patients with pre-operative haemoglobin less than 12.5 g/dL were advised to donate one unit of autologous blood seven to 15 days prior to the date of surgery. The targeted protocol was followed by 2,251 patients: 280 out of 367 anaemic patients donated while 1,971 out of 1,983 nonanaemic patients did not donate. Results Results showed a significantly lower rate of allogeneic transfusion for anaemic patients who predonated than anaemic patients who did not (13 % vs. 37 % respectively, p<0.001). Overall transfusion rates for patients who followed the protocol (n=2,251) were found to be 0.17 units/patient compared to previously reported numbers of 0.75 units/patient when routine donation was used. Among the 2,251 patients who followed the protocol, only 140 patients (6 %) had their autologous blood wasted, in contrast to values reported in the literature ranging from 14 % up to 50 %. Conclusions Targeted PABD reduces the need for allogeneic blood transfusion in anaemic patients and significantly reduces the overall number of transfusions compared to routine pre-operative autologous donation.
2017
Background: Allogenic blood transfusions are expensive and associated with risks and complications such as transmission of infections and incompatibility reactions. Aim: The objective of this study was to evaluate the efficacy of autologous blood transfusion in reducing the need for allogenic blood requirement after total hip replacement and also the cost benefit involved. Method: A retrospective case notes analysis of 178 consecutive patients undergoing total hip replacements from 2006 to 2007 were carried out. 73 patients belonged to Bellovac® ABT (Astra Tech) drains for post-operative blood salvage group (ABT group) and 105 patients belonged to standard Bellovac® (Astra Tech) vacuum drains group (Non-ABT group). Pre and post-operative haemoglobin (Hb) were compared between ABT and Non-ABT group in relation to type of surgery and anaesthesia. Results: 20 out of the 73 (27.3%) patients in ABT group and 45 out of 105 (42.8%) in Non-ABT group required blood transfusion (p=0.035). For...
Blood transfusion following primary hip arthroplasty: a review of transfusion practice
European Journal of Orthopaedic Surgery & Traumatology, 2007
Aim The objective of the study is to assess blood transfusion practices in an orthopaedic unit in order to address the issue of high consumption of banked blood. Areas of weakness in current practice were identiWed and guidelines were produced to help reduce the consumption of allogenic blood. Materials and methods A retrospective audit of case notes and haematological records of 100 patients who had undergone primary total hip replacement (THR) was carried out. Results Ninety-three patients' case notes were available for review. Two groups of patients were identiWed: Transfusion group (N = 72) and Non-transfusion group (N = 21). A total of 170 units of blood were transfused postoperatively on the wards out of 277 cross-matched units, an utilisation rate of 61.3. 91.6% of units transfused were in pairs, with only 8.3% of units transfused given as single units. Conclusions Total hip arthroplasty can be safely performed without requiring blood transfusion in patients without co morbidity, or pre existing haematological disorder. Blood transfusion was higher in patients with a preoperative Hb level of less than 13 g/dl. Cross-matched blood need to be made available to patients in this group and the required units based on our review can be reduced from 4 to 2 in patients undergoing primary THR. A group and save is judged to be an adequate measure for patients with a pre-operative haemoglobin level of 13 g/dl or more.
Relative Risk Factors for Requirement of Blood Transfusion after Total Hip Arthroplasty
Journal of Arthroplasty, 2007
One thousand thirty-five total hip arthroplasty (THA) cases were retrospectively reviewed, and the number and type (autologous and allogenic) of postoperative units of blood transfused were analyzed with respect to pre-, intra-, and postoperative variables. The most significant and consistent predictors of a blood transfusion after THA were advanced age and the use of low-molecular-weight heparin for deep venous thrombosis prophylaxis. Our recommendations for predonation are 1 unit for THA patients younger than 75 years if hemoglobin is 130 g/dL or greater and 2 units or a combination of 1 unit of predonated blood and 1 unit of directed or banked blood for THA patients older than 75 years.
The bone & joint journal, 2013
Autologous retransfusion and no-drainage are both blood-saving measures in total hip replacement (THR). A new combined intra- and post-operative autotransfusion filter system has been developed especially for primary THR, and we conducted a randomised controlled blinded study comparing this with no-drainage. A total of 204 THR patients were randomised to autologous blood transfusion (ABT) (n = 102) or no-drainage (n = 102). In the ABT group, a mean of 488 ml (sd 252) of blood was retransfused. The mean lowest post-operative haemoglobin level during the hospital stay was higher in the autotransfusion group (10.6 g/dl (7.8 to 13.9) vs 10.2 g/dl (7.5 to 13.3); p = 0.01). The mean haemoglobin levels for the ABT and no-drainage groups were not significantly different on the first day (11.3 g/dl (7.8 to 13.9) vs 11.0 g/dl (8.1 to 13.4); p = 0.07), the second day (11.1 g/dl (8.2 to 13.8) vs 10.8 g/dl (7.5 to 13.3); p = 0.09) or the third day (10.8 g/dl (8.0 to 13.0) vs 10.6 g/dl (7.5 to 14...
Hip international : the journal of clinical and experimental research on hip pathology and therapy, 2017
Although total hip arthroplasty (THA) is an effective treatment for end-stage arthritis, it is also associated with substantial blood loss that may require allogeneic blood transfusion. However, these transfusions may increase the risk of certain complications. The purpose of our study is to evaluate: (i) the incidence/trends of allogeneic blood transfusion; (ii) the associated risk factors and adverse events; and (iii) the discharge disposition, length of stay (LOS), and costs for these patients between 2009 and 2013. The National Inpatient Sample database was used to identify 1,542,366 primary THAs performed between 2009 and 2013. Patients were stratified based on demographics, economic data, hospital characteristics, comorbidities, and whether or not allogeneic transfusion was received. Logistic regression was performed to evaluate the risk factors for transfusion and postoperative complications. From 2009 to 2013, allogeneic transfusions were used in 16.9% of primary THAs, with ...
The Journal of bone and joint surgery. American volume, 2004
The aim of this study was to identify clinical factors associated with an increased need for perioperative blood transfusion in nonanemic patients undergoing total hip arthroplasty. We evaluated eighty-five consecutive nonanemic patients who underwent elective, unilateral, cementless, primary total hip arthroplasty and met our inclusion criteria. We attempted to determine whether clinical parameters influencing perioperative blood loss, such as age, gender, hypertension, and body mass index, were also associated with the need for perioperative blood transfusion. Perioperative blood transfusion was required in twenty-four (28%) of the eighty-five nonanemic patients. When considered alone, age, gender, hypertension, and body mass index were not significantly associated with an increased risk of perioperative blood transfusion, on the basis of the numbers available. In contrast, there was a significantly increased risk of blood transfusion when two or more of these clinical parameters ...