Blood management experience: Relationship between autologous blood donation and transfusion in orthopedic surgery

Preoperative autologous donation (PAD) is commonly used for patients underg oing elective total joint arthroplasty; however, PAD is associated with inc reased overall transfusion rates and may not be cost-effective for all pati ents. A retrospective analysis was conducted on a series of 1405 patients u ndergoing unilateral or bilateral total hip or total knee arthroplasty at T he Hospital for Special Surgery to determine the effect of PAD on transfusi on outcomes. Eighty-three percent of patients predonated blood (1 unit to 3 units). Transfusions occurred in 82% of PAD participants and in only 50% o f nondonors. The allogeneic transfusion rates were 8% for PAD participants and 50% for nondonors. Thirty-four percent to 45% of donated autologous uni ts were discarded. Hemoglobin concentrations measured prior to surgery were inversely related to frequency of allogeneic transfusion. These data under score the importance of hemoglobin levels in blood management planning. Thi s information can be useful for formulating rational, cost-effective blood management guidelines.