Possible guidelines for autologous red blood cell donations before total hip arthroplasty based on the surgical blood order equation

Objectives: To determine, in patients undergoing total hip arthroplasty (TH A), clinical predictive criteria for preoperative autologous blood donation and to propose guidelines to increase the efficiency and reduce the cost o f preoperative autologous blood donation. Patients and Methods: In this retrospective analysis of 165 adult patients undergoing primary THA, a stepwise regression analysis was used to determin e which clinical variables predict erythropoiesis in patients donating auto logous blood before THA. The surgical blood order equation (SBOE), which in cludes values for hemoglobin lost at surgery, preoperative hemoglobin level , and minimal acceptable hemoglobin level, was used to estimate the number of units of red blood cells (RBCs) needed for each patient at surgery and t hus identify which patients should have made preoperative autologous blood donations. Results: The statistically significant indicators for RBC production mere p redonation hemoglobin concentration (P<.001) and male ses (P=.003). Combini ng the regression equation for erythropoiesis with the SBOE allowed develop ment of guidelines for the use of preoperative autologous RBC donation and erythropoietic therapy. For primary THA surgery, a patient with a predonati on hemoglobin level higher than 14.7 g/dL does not need preoperative autolo gous donation, Preoperative autologous RBC donation would be effective for men with hemoglobin concentrations of 14.7 g/dL or less and for women with predonation hemoglobin levels of 13.2 to 14.7 g/dL. In women whose hemoglob in level is less than 13.2 g/dL, erythropoietic therapy should accompany au tologous donation, Conclusion: Incorporation of patient factors with the SBOE system may resul t in increased efficiency and decreased cost of autologous blood ordering p ractices before THA.