B. Lisander et al., INTRAOPERATIVE AUTOTRANSFUSION IS ASSOCIATED WITH MODEST REDUCTION OFALLOGENEIC TRANSFUSION IN PROSTHETIC HIP-SURGERY, Acta anaesthesiologica Scandinavica, 42(6), 1998, pp. 707-712
Background: The efficacy of intraoperative salvage and washing of woun
d blood and the predictors of allogeneic red cell transfusions in pros
thetic hip surgery are insufficiently known. Methods: In 96 patients,
undergoing primary or revision surgery, salvaged and washed red cells
and, if necessary, allogeneic blood were used to keep haematocrit not
lower than 33%. The bleeding of red cells during hospital stay was cal
culated from the red cell balance. The preoperative red cell reserve (
millilitres of red cells in excess of a haematocrit of 33%) was estima
ted and the difference between this volume and the total bleeding of r
ed cells was retrospectively used to classify patients with regard to
the need for red cells. Stepwise regression analysis was used to defin
e patient-related variables associated with allogeneic blood transfusi
on. Results: Preoperative knowledge of the type of operation (primary,
revision), the preoperative red cell reserve, and the body mass could
predict roughly half of the need for banked blood (r(2)=0.45). Only o
ne-third of the total bleeding of red cells was retransfused. For comp
lete avoidance of allogeneic blood, autotransfusion was most effective
in patients with a moderate need (0-4 u). However, 32% of such patien
ts required allogeneic blood. Conclusions: Autotransfusion has a limit
ed efficacy to decrease the need for allogeneic blood, and other blood
-saving methods should be added for this purpose. It is difficult to p
redict the need for allogeneic blood preoperatively.