Preoperative platelet-rich plasmapheresis and hemodilution with an autotransfusion device in total hip replacement surgery

The effectiveness of both preoperative autologous donation (PAD) and intrao perative autotransfusion (IAT) with an autotransfusion device has recently been questioned. Preoperative apheresis, with separation of concentrated pl atelet rich-plasma (c-PRP) and erythrocyte concentrate (ERC), represents an aggressive use of the autotransfusion device. Can such a procedure replace PAD in total hip replacement surgery (THR)? Eighty patients undergoing THR were investigated in a prospective and randomized study. Forty patients un derwent PAD, and 2 units of ERC + plasma were retrieved within 4 weeks preo peratively. Another 40 patients underwent an immediately preoperative apher esis with a concomitant hemodilution with 4% albumin, retrieving c-PRP (30% of the platelet pool) and 2 units of ERC. Both groups used IAT up to 2 hou rs postoperatively, with 3% dextran-60 as a plasma substitute according to our standard of cart. There were no differences in blood loss, B-hemoglobin or allogeneic transfusions between the groups: 85% of the patients did not receive allogeneic blood. Both apheresis and reinfusion of c-PRP had minor impact on the coagulation parameters. Platelet count increased slightly bu t significantly (P < 0.05) from 154 to 179 x 10(9)/L after the c-PRP at wou nd closure. Preoperative apheresis with an autotransfusion device, separati ng platelet-rich plasma and erythrocyte concentrate, is a useful alternativ e for patients who are unable to utilize the PAD technique for either relig ious or practical reasons. J. Clin. Apheresis, 15:256-261, 2000. (C) 2000 W iley-Liss, Inc.