TRANSFUSION STRATEGY IN PROGRAMMED HEMORR HAGIC ORTHOPEDIC-SURGERY

Objectives: Prospectively assess autologous blood transfusion for prog rammed orthopedic procedures. Methods: From January 1 to December 31 1 993, 307 patients underwent programmed orthopedic procedures: total hi p replacement (n = 191), total knee replacement (n = 83) and osteotomy (n = 33). General (94%) or spinal anesthesia (6%) was used. The anest hesist explained transfusion techniques and patients gave informed con sent for inclusion in an autologous transfusion protocol including dif fered autologous transfusion, intentional normovolemic hemodilution an d intraoperative transfusion of shed blood. Results: A total of 269 au tologous transfusions were performed among the 307 patients (87.6%). T his was sufficient in 242 cases (78.8%) and in 65 (21.2%) homologous t ransfusion was required. Among the 269 patients given autologous trans fusions, differed transfusion was used in 145 (53.9%), intentional nor movolemic hemodilution in 124 (46%) and intraoperative transfusion of shed blood in 222 (82.5%). Among the patients given a differed autolog ous transfusion, 9 (6.2%) required a homologous transfusion and among the 40 patients in which all 3 techniques were used, only 2 (5%) recei ved homologous blood, both due to secondary complications. Conclusion: These findings show that when differed autologous transfusion is incl uded in the transfusion strategy, less than 10% of the patients requir e homologous blood. In addition, when the 3 autologous transfusion tec hniques are used, the rate of homologous blood transfusion approaches zero.