RED-BLOOD-CELL TRANSFUSIONS FOR TOTAL HIP-REPLACEMENT IN A REGIONAL-HOSPITAL - A 6-YEAR ANALYSIS

To evaluate changes in the need for homologous blood and to assess the imp act of autologous blood transfusion, red cell transfusions in uni lateral total hip replacement surgery, performed electively in the per iod 1986-1991, were studied in a regional hospital. Transfusion data, perioperative blood loss and postoperative haemoglobin concentration o f 495 patients were analysed. From 1986 to 1991, the percentage of pat ients not transfused with homologous blood increased from 18.5 to 45.5 %. After the introduction of an autologous blood transfusion programme in 1987, 116 of 430 patients (27.0%) donated autologous blood. No inc rease in the percentage of autologous donors was observed during the s tudy. Most common reasons for nonparticipation were the patient's age, doctors' underordering and logistic limitations. 81.9% of autologous donors had total hip replacement surgery without homologous transfusio ns. Mean blood loss reduced significantly from 1,373+/-781 ml in 1986 to 958+/-582 ml in 1991 (p<0.001). Transfusion requirement in the nona utologous patients fell from 2.6+/-1.8 units in 1986 to 1.4+/-1.4 unit s per patient in 1989 and increased thereafter to 2.2+/-2.1 units in 1 991 (p<0.01) and showed a strong correlation with blood loss (r=0.58; p<0.001). No changes in postoperative haemoglobin concentration were o bserved throughout the study. In conclusion, collection of autologous blood is effective, albeit still underutilized, to reduce homologous b lood requirement. The close correlation between blood loss and transfu sion requirement accentuates the role of surgical practice in the redu ction of homologous transfusions.