Biology Reference
In-Depth Information
undergone total hip arthroplasty to help determine the predictors for risk for
red blood cell transfusion. They found that in many cases most of the cross-
matched blood was not transfused, leading to wastage and increased costs. It
was thought that if patients at risk of needing transfusions could be identified
before surgery, unnecessary cross-matching and preparation could be elimi-
nated. Pre-operative hemoglobin concentration was judged to be the most sig-
nificant indication for preventing allogeneic transfusions, although age, sex,
aspirin use, and estimated blood loss were other factors. Sculo and Gallino
[24] evaluated 1,405 patients who had total joint replacement. Hemoglobin
concentrations measured before surgery were inversely related to the frequen-
cy of allogeneic transfusions. In other words, the lower the pre-operative blood
parameter values, the higher the allogeneic transfusion rate.
In one of the largest studies, Bierbaum et al. [25] evaluated 9,482 patients
undergoing major orthopedic surgery. The authors not only demonstrated
increased risk of transfusion for patients with a hemoglobin <13 g/dL but a
more complicated post-operative course was also noted in patients receiving a
transfusion. Transfusions were associated with an increased infection rate,
fluid overload,and a longer hospital stay. These studies suggested that the
presurgical goal should be to maximize the patients' blood levels before sur-
gery.
Use of predonated autologous blood (PAD)
In the United States, the current standard of care for patients undergoing ortho-
pedic surgery is predonated autologous blood (PAD), but the use of PAD is
limited and variable in Europe. PAD cannot be used in patients who are ane-
mic (i.e., hemoglobin concentration <11 g/dL in the United States and
<10 g/dL in Europe) or for patients undergoing cardiac surgery. PAD is con-
venient for the physician and relatively convenient for the patient. Some stud-
ies report that PAD may cause further anemia and may be wasteful, at least in
orthopedic setting [26-28].
Hatzidakis et al. [29] performed a retrospective analysis of 489 consecutive
patients undergoing total joint arthroplasty. The study was limited since pre-
donation blood values were only available for 149 of the 489 patients. These
authors reported a decrease in hemoglobin concentration from the time of
donation to the time of surgery (average of 1.22 g/dL). They questioned the
benefit of PAD in patients with pre-donation hemoglobin concentrations
>15 g/dL (>13 g/dL in patients <65 years of age).
Lotke et al. [30] evaluated medical complications after total knee arthro-
plasty. The study was initially designed to evaluate the controversy over the
timing of administration of predonated autologous blood, i.e., should allo-
geneic transfusion and autologous transfusion have the same transfusion crite-
ria. The results of the study suggested that patients who received immediate
transfusion of PAD had fewer non-surgical complications compared with
