Autologous blood transfusion in total knee replacement surgery

Abstract

We compared allogeneic blood usage for two groups of patients undergoing total knee replacement surgery (TKR). Patients were randomized to receive either their post-operative wound drainage as an autotransfusion (n=115) after processing or to have this wound drainage discarded (n=116). Allogeneic blood was transfused in patients of either group whose haemoglobin fell below 9 g dl(-1). Only 7% of patients in the autotransfusion group required an allogeneic transfusion compared with 28% in the control group (P<0.001). There was no hospital mortality and only 3% mortality from all causes at the study completion, which spanned 6 months to 3 yr. There was a higher incidence of infection requiring intervention in the allogeneic group (P<0.036). Total patient costs were Pound Sterling 113 greater in the autotransfusion group. We conclude that in this type of surgery post-operative cell salvage is a safe and effective method for reducing allogeneic blood use.

Local infusion of norepinephrine reduces blood losses and need of transfusion in total knee arthroplasty

“…Furthermore, allogenic blood transfusion increases the risk of immunological and nonimmunological adverse effects for patients, including postoperative infections and disease transmission, and increases medical costs [2][3][4]. For these reasons various methods to reduce blood loss, such as postoperative autotransfusion [9], the use of a femoral intramedullary plug [6] and intravenous administration of tranexamic acid [1,10] have been proposed.…”

Blood Transfusion in Knee Arthroplasty

“…Regarding the use of blood retrieval in total knee ( Dalen et al, 1996;Gannon et al, 1991;Groh et al, 1990;Handel et al, 2006;Heddle et al, 1992;Hendrych, 2006;Kristensen et al, 1992;Majkowski et al, 1991;Martin et al, 1992;Munoz et al, 2005a;Noain et al, 2005;Simpson et al, 1994;Strumper et al, 2004;Thomas et al, 2001;Wojan et al, 2005;Xenakis et al, 1997) and hip (Gannon et al, 1991;Kristensen et al, 1992) arthroplasty, it is considered to be useful as it decreases blood transfusion necessity, reaching a 48% decrease transfusion requirements. The use of postoperative retrieval in knee or hip primary surgery, analyzed from a costbenefit point of view, is a profitable procedure ( Dramis & Plewes, 2006;Jones et al, 2004;Thomas et al, 2001;Wojan et al, 2005). However, some authors like Umlas et al show that the use of a retrieving instrument is not profitable due to its high cost and the small amount of blood retrieved (Umlas et al, 1994).…”

Post-operative Blood Salvage and Retransfusion in Total Hip and Knee Arthroplasty

“…The cost of post-operative blood salvage has been reported to be roughly equivalent to the cost of pre-donating 2 units of blood. 12,13,21 If the cost per unit of allogeneic banked blood, the cost of pre-donation, the average waste of 45 -50% of the pre-donated blood 12,18,26,32 and the cost of the hospital stay 22 are included, post-operative blood salvage and retransfusion is shown to be a more cost-effective procedure for primary total hip and total knee arthroplasty. 12,17 -19,26 In conclusion, many methods exist to decrease the need for allogeneic transfusion.…”