BLOOD-TRANSFUSION STRATEGIES FOR TOTAL KNEE ARTHROPLASTY - MINIMIZINGAUTOLOGOUS BLOOD WASTAGE, RISK OF HOMOLOGOUS BLOOD-TRANSFUSION, AND TRANSFUSION COST
Jl. Knight et al., BLOOD-TRANSFUSION STRATEGIES FOR TOTAL KNEE ARTHROPLASTY - MINIMIZINGAUTOLOGOUS BLOOD WASTAGE, RISK OF HOMOLOGOUS BLOOD-TRANSFUSION, AND TRANSFUSION COST, The Journal of arthroplasty, 13(1), 1998, pp. 70-76
In this nonrandomized study, alternative strategies were suggested to
10 orthopaedic surgeons to minimize autologous blood wastage, the risk
of homologous blood transfusion, and cost associated with blood produ
ct usage after total knee arthroplasty (TKA). One hundred fifty-five p
atients with 177 consecutive TKAs over a 2-year period were studied. G
roup 1 patients had undergone unilateral TKA and did not predonate; 1A
patients (n = 19) were drained with a Hemovac, and 1B patients (n = 2
8) with a postoperative blood recovery system. Group 2 patients (n = 4
7) predonated one packed red blood cell (pRBC) unit. Group 3 patients
(n = 20) predonated 2 pRBC units. Group 4 patients had undergone bilat
eral sequential TKAs (n = 21) and had predonated 2 pRBC units. Group 5
patients (n = 14) had undergone revision TKA procedures and their blo
od requirements were individualized. Group 6 patients (n = 6) had pree
xisting anemia and were excluded from the study. There was no signific
ant difference in total blood loss (909 mL) between groups. Female sex
was associated with significantly lower admission hematocrit. Homolog
ous blood was required for 4% of patients in the entire study and the
percentage was not statistically different between groups. Twenty-five
percent of patients who predonated autologous pRBCs did not use all o
r some of it. In group 1, the postoperative blood recovery system had
a significant effect on reducing postoperative hematocrit drop (P = .0
001), but it was not a significant factor if autologous pRBCs were ava
ilable. The costs associated with group 1A were significantly less (P
= .0001) compared with the other groups; group 1A had the highest admi
ssion hematocrit (43.2). Transfusion with autologous pRBCs was related
to lower admission hematocrit rather than to increased postoperative
blood loss. An algorithm is presented to provide cost-effective manage
ment of blood products after TKA.