Effect of shed blood retransfusion on pulmonary perfusion after total knee arthroplasty: a prospective controlled study

Abstract

Postoperative shed blood retransfusion (autotransfusion) is a commonly used salvage method following major surgical operations, such as total knee arthroplasty (TKA). The systemic effects of shed blood are still unclear. We studied the effect of residual substances in the retransfused shed blood, on lung perfusion after TKA. Fifteen unilateral and one bilateral TKAs were performed with autotransfusion (the study group) and 15 unilateral and three bilateral TKAs were performed in a control group. Lung Xrays, arterial blood gases (ABG), D-dimer values, and lung perfusion scintigraphies were performed preoperatively and postoperatively. A mean of 300.0±335.6 ml of bank blood was needed in the autotransfusion group and a mean of 685.7±365.5 ml of bank blood was needed in the control group (p=0.001). There was a postoperative segmental perfusion defect at the lateral segment of the superior lobe of the left lung in one patient of the control group and he also had risk factors for thrombosis. Although both groups had a decrease in lung perfusion postoperatively, there were no significant differences among the groups regarding the lung perfusion scintigraphy, chest X-rays, ABG, and Ddimer values. In conclusion, although pulmonary perfusion diminishes following TKA, shed blood retransfusion does not add any risk to pulmonary perfusion. Résumé La retransfusion post-opératoire est souvent utilisée dans les interventions majeures comme les prothèses de genou. L'effet systémique du sang récupéré n'est pas très connu. Nous avons étudié les effets de cette transfusion sur la perfusion pulmonaire. 15 prothèses de genou unilatérales et une bilatérale étaient réalisées en autotransfusion avec un groupe de contrôle de 15 unilatérales et 3 bilatérales. Des radiographies pulmonaires, les gaz du sang, la valeur des Ddimer et des scintigraphies de la perfusion pulmonaire étaient faites avant et après l'opération. Une moyenne de 300,0+−335,6 ml de sang de banque était nécessaire dans le groupe autotransfusion et une moyenne de 685,7+−365,5 ml était nécessaire dans le groupe de contrôle (p=0,001). Il y avait un déficit segmentaire de perfusion chez un patient du groupe de contrôle et il avait aussi des facteurs de risque thrombotique. Bien que les 2 groupes avaient une diminution de la perfusion pulmonaire, il n'y avait pas de différ-ences entre les 2 groupes pour la scintigraphie pulmonaire, les radiographies, les gaz du sang et les valeurs des D-dimer. En conclusion, bien que la perfusion pulmonaire diminue à la suite de l'arthroplastie totale de genou, la retransfusion du sang répandu n'entraine pas de risque particulier.

Cell salvage for minimising perioperative allogeneic blood transfusion

“…Drains were maintained for 24 hours post-operatively.Group 3: A standard disposable closed suction drainage system (Redon) was used with two standard drains maintained for 24 hours post-operatively.Outcomes Outcomes reported: number of patients transfused allogeneic blood, blood loss, hospital length of stay, Hb and Hct levelsNotes Transfusion threshold: allogeneic blood transfusion was given if the haemoglobin level was less than 9.0g/dL Risk of bias Bias Authors’ judgement Support for judgement Random sequence generation (selection bias)High riskRandomisation was carried out with sealed envelopes, opened just before closure of the wound. Method used to generate allocation sequences was not describedAllocation concealment (selection bias)High riskSealed envelopes were used to conceal treatment allocation.Blinding (performance bias and detection bias)All outcomesHigh risk Altinel 2007…”

Comparison of Cardiopulmonary Complication Rates in Patients Undergoing Total Knee Arthroplasty and Reinfusion of Shed Blood

“…A study conducted by Altinel et al (2007) looked at the effect of residual substances in the retransfused shed blood on lung perfusion in TKA. This study included 30 subjects, 15 in the group that used the autotransfusion and 15 in the control group without the use of the autotransfusion.…”