Pre-operative injections of epoetin-α versus post-operative retransfusion of autologous shed blood in total hip and knee replacement

Abstract

This prospective randomised clinical trial evaluated the effect of alternatives for allogeneic blood transfusions after total hip replacement and total knee replacement in patients with pre-operative haemoglobin levels between 10.0 g/dl and 13.0 g/dl. A total of 100 patients were randomly allocated to the Eprex (pre-operative injections of epoetin) or Bellovac groups (post-operative retransfusion of shed blood). Allogeneic blood transfusions were administered according to hospital policy. In the Eprex group, 4% of the patients (two patients) received at least one allogeneic blood transfusion. In the Bellovac group, where a mean 216 ml (0 to 700) shed blood was retransfused, 28% (14 patients) required the allogeneic transfusion (p = 0.002). When comparing Eprex with Bellovac in total hip replacement, the percentages were 7% (two of 30 patients) and 30% (nine of 30 patients) (p = 0.047) respectively, whereas in total knee replacement, the percentages were 0% (0 of 20 patients) and 25% (five of 20 patients) respectively (p = 0.042). Pre-operative epoetin injections are more effective but more costly in reducing the need for allogeneic blood transfusions in mildly anaemic patients than post-operative retransfusion of autologous blood.

Rheumatoid Arthritis vs Osteoarthritis in Patients Receiving Total Knee Arthroplasty: Perioperative Outcomes

“…RA patients are more prone to receive blood product transfusions postoperatively. Appropriate blood loss and transfusion management should be deliberated in due time in patients suffering from RA, including shed blood retransfusion, preparation of autologous blood as well as preoperative injection of epoetin [28, 42] . The finding of increased requirement for health care resources may in part pertain to the more thorough preparation for surgery that RA patients receive.…”

A Prospective Randomized Controlled Trial to Assess the Effect of Intravenous versus Oral Iron Therapy in the Treatment of Preoperative Anaemia

“…The use of recombinant human erythropoietin or autologous blood transfusion pre-operatively have been suggested as ways to manage preoperative anaemia [26,27]. A review of the evidence based outcomes of the different supplementations in hip and knee surgery suggested that iron therapy, both oral and intravenous have been shown to reduce the need for allogeneic blood transfusion and significantly reduced the post-operative infection rate [28][29][30][31].…”

“…A systemic review comparing the evidence of administering erythropoietin with iron supplements to an active control group of either iron supplementation or cell salvage [26,30], showed that the clinical outcomes of post-operative infections, length of stay and 30 day mortality were generally not significant when compared to the active control group in these studies.…”

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

“…Its role in blood loss management has been thoroughly studied, showing a 60% reduction of ABTs in patients who received EPO compared to control group[28-30]. Three or four weekly subcutaneous injections (600 IU/kg) seems to be the most frequently used protocol with the best results[31-35]. Weber et al[36] reports a mean rise in pre-operative Hb of 1.9 g/dL in patients that received EPO.…”