Risks associated with blood transfusion after total knee arthroplasty

Bong, Matthew R.; Patel, Vipul; Chang, Eric Y.; Issack, Paul S.; Hebert, Rudi; Cesare, Paul E. Di

doi:10.1016/j.arth.2003.10.013

Cited by 175 publications

(136 citation statements)

References 19 publications

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“…Substantial bleeding may occur at intraarticular and subcutaneous sites after TKA [11,17,24,32,40,43], and this can result in blood transfusion, which has been associated with many complications [5,6]. In addition, excessive bleeding may lead to intraarticular or subcutaneous hematoma formation, which can impair wound healing, restrict mobilization, and increase the risk of deep infection [18,22,31].…”

Section: Introductionmentioning

confidence: 99%

Subcutaneous versus Intraarticular Indwelling Closed Suction Drainage after TKA: A Randomized Controlled Trial

Seo

Yoon

Koh

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background TKA can involve substantial bleeding, and the issue regarding whether vacuum drainage should be used during TKA continues to be debated as both methods have disadvantages. Questions/purposes We therefore asked whether subcutaneous indwelling vacuum drainage is advantageous over intraarticular indwelling vacuum drainage in terms of blood drainage, bleeding-related complications, and functional outcomes in primary TKA. Patients and methods We randomized 111 patients undergoing TKAs to have either a subcutaneous indwelling or an intraarticular indwelling catheter and compared the two groups for blood loss (hemoglobin decrease, transfusion requirements, hypotension episode), incidence of wound problems (requirements for dressing reinforcement,

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Section: Introductionmentioning

confidence: 99%

Subcutaneous versus Intraarticular Indwelling Closed Suction Drainage after TKA: A Randomized Controlled Trial

Seo

Yoon

Koh

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…The method of wound closure is a confounding variable and makes it difficult to compare the results of our study others. Bong et al [1], in a retrospective review of 1402 knee arthroplasty cases using multivariate regression analysis, concluded that the need for allogeneic transfusion was highest in patients treated with LMWH as compared with those The meta-analysis by Parker et al [9] theorized that the primary outcome of any drain study should be the incidence of wound infection. Wound infections can stem from many sources, so determining the efficacy of a drain for prevention of this complication has proven difficult.…”

Section: Discussionmentioning

confidence: 99%

“…Concerns exist over potential bleeding complications, systemically and at the surgical site, although studies comparing LMWH with warfarin and unfractionated heparin have not demonstrated that statistical bleeding rate differences exist. However, a large retrospective review [1] determined that patients receiving LMWH prophylaxis after primary TKA were 28% more likely to require a transfusion when compared with patients treated with mechanical prophylaxis and aspirin.…”

Section: Introductionmentioning

confidence: 99%

The Use of Reinfusion Drains after Total Knee Arthroplasty in Patients Treated with Low Molecular Weight Heparin for Thromboembolic Prophylaxis

Gordon

Pulido

Copp

et al. 2005

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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The effect of closed-suction drainage with redcell reinfusion on patients receiving low molecular weight heparin (LMWH) prophylaxis after total knee arthroplasty (TKA) has not been previously studied. Therefore, our goals were to determine the effect of reinfusion drains and LMWH on allogeneic transfusions and wound complications after TKA by comparing patients treated with and without drains. Overall, transfusion rates were lower in the drain group (40% vs 15%, P=.04). Patients with reinfusion drains had a significantly higher rate of allogeneic transfusion (15.8%) than those predonating autologous blood and no drain (5.4%, P=.0003). The drain group had lower rates of wound complications (P=not significant). We were unable to demonstrate the efficacy of red-cell reinfusion as a substitute for autologous donation in TKA.

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“…For blood loss management during TKA, preoperative autologous blood donation (PABD) is still a standard of care. Although improvement of screening techniques has almost eliminated the risk of blood-transmitted diseases, there is still a risk during transfusions of allergic reactions, post-operative infections and transfusion reactions when allogeneic blood transfusions are used [4,5]. Complications such as bacterial contamination, febrile non-haemolytic transfusion reaction or iatrogenic anaemia can be seen when autologous blood is used.…”

Section: Introductionmentioning

confidence: 99%

“…Complications such as bacterial contamination, febrile non-haemolytic transfusion reaction or iatrogenic anaemia can be seen when autologous blood is used. This could also increase the need for allogeneic transfusions [1,4,6]. Usually TKA is performed under tourniquet and intra-operative blood losses are low.…”

Section: Introductionmentioning

confidence: 99%

Pre-operative autologous blood donation versus no blood donation in total knee arthroplasty: a prospective randomised trial

Blazekovic

Bićanić

Hrabač

et al. 2013

International Orthopaedics (SICOT)

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Purpose During total knee arthroplasty (TKA) blood loss can be significant and in spite of all techniques for reducing blood loss there is still a significant possibility for blood transfusions. For blood loss management during TKA, pre-operative autologous blood donation (PABD) is still a standard of care. In this prospective randomised study we have evaluated the efficacy of PABD in patients undergoing TKA to answer the question whether there is any need for autologous blood donations during TKA and, if yes, for which group of patients. Methods Patients were randomised to three groups. In group 1 patients did not donate autologous blood, in group 2 patients donated 1 dose 72 hours prior to TKA and in group 3 patients donated autologous blood 14 days prior to TKA. In all patients haemoglobin, haematocrit, thrombocyte and reticulocyte values, iron concentrations (Fe, unsaturated iron binding capacity, total iron binding capacity), activated partial thromboplastin time, prothrombin time, and intra-operative and postoperative blood loss were measured and compared. Results With PABD there was no reduction in allogeneic blood transfusions and a large number of taken doses of autologous blood was discarded, which significantly increased the cost of treatment for these patients. For patients undergoing TKA, PABD can provoke iatrogenic anaemia and thereby increase the likelihood of the need for allogeneic blood transfusion. Conclusions Results of our study showed that PABD in nonanaemic patients is not justified and is not economically feasible.

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Risks associated with blood transfusion after total knee arthroplasty

Cited by 175 publications

References 19 publications

Subcutaneous versus Intraarticular Indwelling Closed Suction Drainage after TKA: A Randomized Controlled Trial

Subcutaneous versus Intraarticular Indwelling Closed Suction Drainage after TKA: A Randomized Controlled Trial

The Use of Reinfusion Drains after Total Knee Arthroplasty in Patients Treated with Low Molecular Weight Heparin for Thromboembolic Prophylaxis

Pre-operative autologous blood donation versus no blood donation in total knee arthroplasty: a prospective randomised trial

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