Blood conservation in hip trauma

Patients with hip or pelvic fractures experience significant blood loss as a result of the fracture and from the surgery that subsequently is performe d. The emergent and unplanned nature of fracture surgery precludes the use of preoperative blood donation and the optimization of chronic medical prob lems. Blood transfusion frequently is required to maintain adequate tissue O-2 delivery in these injured patients. However, the administration of allo geneic blood causes other problems, including a well documented increase in the risk of infectious complications. Perioperative measures to minimize b lood loss such as hypotensive anesthesia and red blood cell salvage are imp ortant, but often are inadequate to prevent the need for blood transfusion. Recently, erythropoietin therapy has been shown to stimulate hematopoiesis in patients with hip fractures. The authors discuss their experience with blood loss management in these patients with hip injuries, including aggres sive Fe replacement therapy and the use of recombinant human erythropoietin .