Effectiveness of a protocol to improve transfusion practice in knee replacement surgery

Abstract

A transfusion algorithm, together with staff education, is effective in reducing both the number of patients transfused and inappropriate transfusions.

Which patients are more likely to benefit from postoperative shed blood salvage after unilateral total knee replacement? An analysis of 581 consecutive procedures

“…In a previous studies, we found that USB return did not modify either the acute phase response or the cellular immune response to TKR [15,16], but it decreased the risk of receiving an ABT (48% vs. 11%, P < 0·01) and reduced the ABT index by 1 unit [9]. However, a transfusion protocol was not established, probably leading to unnecessary transfusions [17], as ABT rate in the control group was higher than that reported in recent TKR series [1,8,18,19]. In this present study, the introduction of a transfusion protocol (transfusion trigger, Hb < 9 g/dl) resulted in a reduction of ABT rate in patients managed without USB return with respect to our previous series (48% vs. 30·6%; relative risk (RR): 0·60, P < 0·01).…”

“…G, general anaesthesia; R, regional anaesthesia. in recent TKR series [1,8,18,19]. In this present study, the introduction of a transfusion protocol (transfusion trigger, Hb < 9 g/dl) resulted in a reduction of ABT rate in patients managed without USB return with respect to our previous series (48% vs. 30·6%; relative risk (RR): 0·60, P < 0·01).…”

Use of factor concentrates for the management of perioperative bleeding: reply

“…4. We fully agree with Sargant et al and with the authors of many studies [8][9][10][11][12] and guidelines [7] that a protocol for surgical blood loss management with clear objectives can help the team to focus on specific tasks and can facilitate a rapid response. Such a protocol should incorporate predefined triggers and targets to guide individualized hemostatic interventions.…”

Silent myocardial ischaemia and haemoglobin concentration: a randomized controlled trial of transfusion strategy in lower limb arthroplasty

“…Additional benefit could be accrued if, when a restrictive policy is in place, ‘group and save’ protocols were in place, rather than having crossmatched blood available, regardless of need. This may itself decrease the possibility of transfusion [43]. The potential savings of implementing a restrictive transfusion policy are impressive.…”