Targeted Preoperative Autologous Blood Donation in Total Knee Arthroplasty Reduces the Need for Postoperative Transfusion

HSS Journal: Volume 9 Issue 3

Jad Bou Monsef, MD,
Hospital for Special Surgery

Johannes Buckup, MD,
Hospital for Special Surgery


David J. Mayman, MD

Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery
Clinical Co-Director, Computer Assisted Surgery (CAS) Center, Hospital for Special Surgery
Assistant Professor in Orthopedic Surgery, Weill Cornell Medical College

Robert G. Marx, MD, MSc, FRCSC

Attending Orthopaedic Surgeon, Hospital for Special Surgery
Professor of Orthopaedic Surgery and Professor of Public Health, Weill Cornell Medical College

Amar S. Ranawat, MD

Associate Professor of Orthopaedic Surgery, Weill Cornell Medical College
Associate Attending Orthopaedic Surgeon, NewYork-Presbyterian Hospital
Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery

Friedrich Boettner, MD

Assistant Attending Orthopaedic Surgeon, Hospital for Special Surgery
Assistant Professor of Orthopaedic Surgery, Weill Cornell Medical College

Abstract

Background
Preoperative donation of autologous blood has been widely used to minimize the potential risk of allogeneic transfusions in total knee arthroplasty. A previous study from our center revealed that preoperative autologous donation reduces the allogeneic blood exposure for anemic patients but has no effect for non-anemic patients.

Questions/Purposes
The current study investigates the impact of a targeted blood donation protocol on overall transfusion rates and the incidence of allogeneic blood transfusions.

Methods
Prospectively, 372 patients undergoing 425 unilateral primary knee replacements were preoperatively screened by the Blood Preservation Center between 2009 and 2012. Anemic patients with a hemoglobin level less than 13.5 g/dL were advised to donate blood, while non-anemic patients did not donate.

Results
Non-anemic patients who did not donate blood required allogeneic blood transfusions in 5.9% of the patients. The overall rate of allogeneic transfusion was significantly lower for anemic patients who donated autologous blood (group A, 9%) than those who did not donate (group B, 33%; p <#0.001). Donating autologous blood did increase the overall transfusion rate of anemic patients to 0.84 per patient in group A compared to 0.41 per patient in group B (p < 0.001).

Conclusion
This investigation confirms that abandoning preoperative autologous blood donation for non-anemic patients does not increase allogeneic blood transfusion rates but significantly lowers overall transfusion rates.

Level of Evidence
Therapeutic Study Level II. See Levels of Evidence for a complete description.

This work was performed at the Hospital for Special Surgery, New York, NY.

This article appears in HSS Journal: Volume 9 Issue 3.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.

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