HOMOLOGOUS BLOOD-TRANSFUSION AND POSSIBIL ITIES OF AUTOLOGOUS BLOOD USAGE IN TOTAL KNEE AND HIP-REPLACEMENT

In a retrospective study we documented the need for blood transfusion in total knee (TKR) and hip replacement (THR). The problems with homol ogous blood transfusion in orthopedic surgery and alternative techniqu es of autologous-blood transfusions are discussed. In this series pati ents with primary THR needed 1.69 (+/- 2.25) blood units, with primary TKR 1.58 (+/- 1.54) blood units, and secondary TKR 1.19 (+/- 1.47) bl ood units. Secondary THR required significantly more units (3.85 +/- 3 .07). These procedures also asked for significantly more plasma (3.27 +/- 3.95) than all other procedures. For secondary THR 2.63 (+/- 2.45) blood units were intraoperatively used and only 1.23 (+/- 1.09) blood units postoperatively. All otehr procedures needed postoperatively si gnificant more units than intraoperatively. In secondary THR the use o f blood transfusions increased with age. 45% of the patients with prim ary THR and 15% with secondary THR were operated without additional bl ood transfusion. In secondary THR 36% of all patients needed more than 4 blood units and 27% more than 4 plasma units. In TKR 39% of the pri mary cases and 50% of the secondary cases were operated on without add itional homologous blood. Based on these results we established a tran sfusion concept for our department. Economic, practical, as well as le gal aspects were taken into account.