REINFUSION OF POSTOPERATIVE WOUND DRAINAGE IN TOTAL JOINT ARTHROPLASTY - RED-BLOOD-CELL SURVIVAL AND COAGULOPATHY RISK

Fifty patients with total joint arthroplasties (28 total hip arthropla sties, 11 total knee arthroplasties, and 11 bilateral total knee arthr oplasties) received autotransfusions from their postoperative wound dr ainage. The blood was collected in a closed sterile drainage system wi thout any additional anticoagulant. Pre- and postoperative measurement s were made of the patient's hemoglobin, platelets, fibrinogen, haptog lobin, fibrin degradation products, and D-dimer (a specific type of fi brin degradation product). Red blood cell survival was assessed in 16 of the patients by labeling the shed blood with Cr-51 sodium chromate prior to reinfusion. To control for fluid shifts, continued bleeding, and dilution effects of further transfusions in the immediate postoper ative period, 10 patients also had their native blood labeled with In- 111 oxime. In this study, the mean estimated blood loss was 1,062 mL ( +/-1,247) with a mean wound drainage of 836 mL (+/-338). Of this, a me an of 450 mL (+/-261) of blood was was given back to the patient in ad dition to routine, preoperative autologous donated blood. Six (12%) pa tients experienced transient fevers at the time of retransfusion. Deta iled hematologic studies were performed on the shed blood in 19 patien ts. The collected blood was completely defibrinated, but did contain f ibrin degradation prod ucts, as indicated by the D-dimer level, and he molyzed blood as the haptoglobin was reduced. Even though the blood co ntaining the above breakdown products was reinfused to the patients, t here were no clinical manifestations of disseminated intravascular coa gulation. Both the hemolyzed and defibrinated products were subsequent ly cleared by the body. After correcting for fluid and volume changes in the first 3 days, 66% (SEM, 5.3%) of the labeled red blood cell act ivity remained and was used to determine a mean red blood cell surviva l half-life of 40.6 days (SEM, 4.2). There was no significant change i n the In-111:Cr-51: ratio in the first 24 hours, indicating that the i nitial drop in activity equally affected both the native red blood cel l population and the labeled shed blood. There were no adverse clinica l effects resulting from a transient coagulopathy. Autotransfusion of postoperative shed red blood cells is a safe method with reinfused cel ls that have a normal or increased lifespan.