Targeted pre-operative autologous blood donation: a prospective study of two thousand and three hundred and fifty total hip arthroplasties

Abstract

Purpose Pre-operative donation of autologous blood has been widely used in elective joint replacement procedures to avoid the risks of allogeneic blood transfusions. However, the high percentage of wasted autologous blood questions the general efficacy of pre-operative autologous blood donation (PABD) for all patients undergoing hip replacement. This study prospectively investigates the impact of a targeted pre-operative autologous blood donation protocol for anaemic patients on allogeneic and overall transfusion rates in 2,350 unilateral primary total hip arthroplasty procedures. Methods Patients with pre-operative haemoglobin less than 12.5 g/dL were advised to donate one unit of autologous blood seven to 15 days prior to the date of surgery. The targeted protocol was followed by 2,251 patients: 280 out of 367 anaemic patients donated while 1,971 out of 1,983 nonanaemic patients did not donate. Results Results showed a significantly lower rate of allogeneic transfusion for anaemic patients who predonated than anaemic patients who did not (13 % vs. 37 % respectively, p<0.001). Overall transfusion rates for patients who followed the protocol (n=2,251) were found to be 0.17 units/patient compared to previously reported numbers of 0.75 units/patient when routine donation was used. Among the 2,251 patients who followed the protocol, only 140 patients (6 %) had their autologous blood wasted, in contrast to values reported in the literature ranging from 14 % up to 50 %. Conclusions Targeted PABD reduces the need for allogeneic blood transfusion in anaemic patients and significantly reduces the overall number of transfusions compared to routine pre-operative autologous donation.

Surgical Technical Evidence Review for Elective Total Joint Replacement Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery

“… 15 The most frequently used definition of anemia is the World Health Organization (WHO) 19 classification using a hemoglobin <13 g/dL (men) and <12 g/dL (women). Two SRs, 14 , 20 1 RCT, 21 and several observational studies 22 – 26 have shown iron (oral and intravenous) supplementation, erythropoietin, and preoperative autologous donation are effective in reducing postoperative allogenic transfusion; however, the benefit on clinical outcomes (ie, LOS and mortality) is unclear. Routine use of these strategies does not appear to benefit nonanemic patients.…”

Prospective study of preoperative autologous blood donation for patients with high risk of allogeneic blood transfusion in lumbar fusion surgery: a study protocol of a randomised controlled trial

“…In this study, a validated risk score system of allogeneic blood transfusion for lumbar fusion surgery based on retrospective study with large sample size will be implemented to ensure the necessity for PABD programme. Both this technique and EPO injection should be more efficient in the patients with higher risk of blood transfusion 20 24. Waste of donated blood was an inherent risk for PABD programme 25 26.…”