Blood Management Protocol for Total Knee Arthroplasty to Reduce Blood Wastage and Unnecessary Transfusion

Abstract

Purpose. To compare outcomes of 2 cohorts of patients who underwent total knee arthroplasty (TKA) before and after the introduction of a blood management protocol. Methods. Records of 97 and 96 consecutive patients who underwent unilateral TKA before and after introduction of the blood management protocol, respectively, were reviewed. Before introduction of the protocol, patients were cross-matched for blood before surgery. Transfusion after surgery was at the discretion of the surgeons or the on-call doctors. After introduction of the protocol, only patients with a preoperative haemoglobin level of <110 g/l underwent 'type and screening' of blood group. 2 units of blood were cross-matched preoperatively when multiple red-cell antibodies were identified or postoperatively when blood transfusion was required. Only patients with a postoperative haemoglobin level of <80 g/l or being symptomatic received blood transfusion until the haemoglobin level reached >100

What Should Define Preoperative Anemia in Primary THA?

“…This has important implications preoperatively since compared with sex and the inability to receive TXA, this is a modifiable variable. The identification and treatment of preoperative anemia before lower extremity arthroplasty with specialist referral, iron supplementation, and erythropoietin-stimulating agents have been shown to reduce transfusions, LOS, 90-day readmissions, and costs [9,15,17,20,22,24,36], yet there are no guidelines or cutoffs to suggest which patients would benefit from these treatment programs or to identify preoperative Hgb targets to ensure one is ''ready'' for THA. We recommend that in addition for screening with BMI and hemoglobin A1c for obesity and diabetes, respectively, patients have preoperative hemoglobin checked 4 weeks before THA [15].…”

Clinical outcomes of fast-track total knee arthroplasty for patients aged >80 years

“…14 These factors presumably contributed to the significant increases in the rates of transfusion and 'type and screen' in the octogenarian group, despite a similar haemoglobin reduction and the use of 8 g/dL as the transfusion threshold in both groups. 15 Because perioperative anaemia and allogenic blood transfusion have been associated with an increased risk of postoperative infection, longer hospital stay, and greater mortality, 16 iron supplements and autologous transfusion were used to increase the preoperative haemoglobin level and reduce the postoperative transfusion rate. Our fast-track protocol-driven blood management with a single transfusion threshold provides a good balance between adequate treatment of perioperative anaemia and unnecessary blood transfusion.…”

Association between preoperative hemoglobin and postoperative moderate and severe anemia among patients undergoing primary total knee arthroplasty: a single-center retrospective study

“…Generally, mild anemia could be corrected by oral iron supplements, reinforced nutrition. By comparison, PMSA was usually difficult to resolve, needing further treatments, such as intravenous iron, erythropoietin, even transfusion [ 17 , 18 ]. Moreover, patients who developed PMSA had higher risk of developing postoperative complications relative to patients with mild anemia following joint replacement [ 19 ].…”