Recombinant human erythropoietin in preoperative autologous blood donation did not influence the haemoglobin recovery after surgery

BACKGROUND: Recombinant human erythropoietin in combination with preoperative autologous blood donation is an established regime for avoiding allogenic blood transfusions. The aim of the study was to determine endogenous erythropoietin production and haemoglobin recovery after preoperative autologous blood donation and surgery, with or without recombinant human erythropoietin treatment. METHODS: Thirty-eight patients having total hip joint replacement surgery were randomised to receive either autologous blood transfusion (control group) or autologous transfusion plus preoperative recombinant human erythropoietin treatment (EPO group). Haemoglobin, haematocrit, erythropoietin and reticulocyte concentrations were repeatedly analysed, before, during, and after surgery. RESULTS: No significant differences were found between the groups regarding haemoglobin, haematocrit, and erythropoietin, but the reticulocyte count increased significantly more in the EPO group. There was no difference in the requirement for allogeneic blood transfusions between the groups. The baseline haemoglobin was >13 g dL-1 in all but four patients. CONCLUSIONS: In patients with normal preoperative haemoglobin levels, recombinant human erythropoietin treatment did not improve haemoglobin levels, or reduce the need for allogenic blood transfusion. There were no differences in serum erythropoietin concentrations between the groups. We question whether recombinant human erythropoietin treatment facilitates preoperative autologous blood donation in patients with normal haemoglobin levels.     

State-of-the-art blood saving techniques

Preoperative autologous donation, the use of erythropoietin, acute normovolaemic haemodilution, acceptance of minimal perioperative haemoglobin levels, the use of specific drugs (aprotinin, antifibrinolytics), cell saving and a meticulous surgical technique aimed at minimizing blood loss have all been described as blood saving techniques. Each has proved effective in reducing the need for allogeneic blood transfusions. With an appropriate selection of patients, all techniques can be used efficiently.     

Blood salvage in total hip and knee arthroplasty in a community hospital: a retrospective study

PURPOSES: To assess the results of postoperative and intra-operative blood salvage in patients undergoing total knee and hip arthroplasty, respectively, and to determine if both methods of blood salvage reduce allogeneic transfusion. METHODS: Of 229 patients who attempted blood salvage, 114 of 152 patients who underwent total knee arthroplasty received the salvaged blood postoperatively, 35 of 77 patients who underwent total hip arthroplasty received the salvaged blood intra-operatively. Various data were collected to assess whether certain factors resulted in autologous and/or allogeneic blood transfusions. RESULTS: Patients that received postoperative salvaged blood after total knee arthroplasty generally had higher postoperative levels of haemoglobin and haematocrit compared to those who did not. Patients with autologous blood transfusion following cemented knee surgery were less likely to require allogeneic blood transfusion. For hip arthroplasty patients, postoperative levels of haemoglobin and haematocrit were similar in both groups who received and did not receive salvaged blood. Lower preoperative haemoglobin and haematocrit levels correlated with a greater likelihood of autologous and/or allogeneic blood transfusion for both knee and hip arthroplasty patients. CONCLUSIONS: Although total knee arthroplasty patients who received salvaged blood had higher haemoglobin levels on the first postoperative day, the receipt of salvaged blood did not significantly reduce the incidence of allogeneic blood transfusion, because salvaged blood was a kind of blood loss. However, reinfusion of salvaged blood may reduce the number of units of allogeneic blood used. Given the short supply of allogeneic blood and its risks of transmitting disease, intra-operative and postoperative blood salvage carries clear advantages.     

Contribution de l'hémodilution préopératoire par érythrophérèse à l'épargne de sang homologue au cours de l'arthroplastie totale de hanche

ObjectivesTo compare three techniques for decreasing homologous blood requirements in total hip arthroplasty (THA), including preoperative autologous donation (PAD), preoperative acute normovolaemic haemodilution with erythrocytapheresis (erythro) and intraoperative normovolaemic haemodilution (haemo).Study designProspective clinical trial.PatientsThe study included 45 patients scheduled for THA, under general anaesthesia and operated on by the same surgeon. The patients were allocated into three groups of 15 each.MethodsBlood loss was assessed, during surgical procedure, by the weight of sponges and, the amount of blood collected in the suction bottles during and after surgery. The haemoglobin concentration was measured at the time of preoperative assessement (d-30), just prior to surgery (d-1), in the recovery room (d+3h), and 1, 3, and 8 days later (d8). The transfusion end-point in the three groups was to obtain a haemoglobin concentration of 100 g·L⁻¹ from d+3h until d8. Every pack of red blood cells transfused was weighed and its haematocrit assessed to determine the accurate volume of red blood celts.ResultsIn the three groups haemoglobin concentration was similar from d+3h until d8. In the PAD group, no patient required homologous blood transfusion. There was no significant difference between the two other groups in the mean volume of homologous red blood cells required (308 ± 197 mL in erythro group and 331 ± 202 mL in the haemo group, respectively). The intraoperative blood loss was significantly higher (P = 0.001) in the erythro group: 914 ± 305 ml vs 665 ± 263 in the PAD group and 512 ± 146 ml in the haemo group, respectively. There was an inverse correlation between haematocrit at d-1 and intraoperative bleeding (r = −0.7) (P = 0.0001). The distribution of the points was fitted as an exponential curve.ConclusionsIn THA, PAD is obviously the best technique to avoid homologous blood transfusion. However, when PAD is not feasible, removal of blood prior to surgery does not decrease requirements of homologous blood, as intraoperative blood loss is higher. Our results strongly question the use of major haemodilution during a surgical procedure exposing a major blood loss.     

A prospective randomized comparison of three blood conservation strategies for radical prostatectomy.

BACKGROUND: Preoperative autologous blood donation is a standard of care for elective surgical procedures requiring transfusion. The authors evaluated the efficacy of alternative blood-conservation strategies including preoperative recombinant human erythropoietin (rHuEPO) therapy and acute normovolemic hemodilution (ANH) in radical retropubic prostatectomy patients. METHODS: Seventy-nine patients were prospectively randomized to preoperative autologous donation (3 U autologous blood); rHuEPO plus ANH (preoperative subcutaneous administration of 600 U/kg rHuEPO at 21 and 14 days before surgery and 300 U/kg on day of surgery followed by ANH in the operating room); or ANH (blinded, placebo injections per the rHuEPO regimen listed previously). Transfusion outcomes, perioperative hematocrit levels, postoperative outcomes, and blood-conservation costs were compared among the three groups. RESULTS: Baseline hematocrit levels were similar in all groups (43%+/-2%). On the day of surgery hematocrit decreased to 34% +/-4% in the preoperative autologous donation group (P < 0.001), increased to 47%+/-2% in the rHuEPO plus ANH group (P < 0.001), and remained unchanged at 43%+/-2% in the ANH group. Allogeneic blood exposure was similar in all groups. The rHuEPO plus ANH group had significantly higher hematocrit levels compared with the other groups throughout the hospitalization (P < 0.001). Average transfusion costs were significantly lower for ANH ($194+/-$192) compared with preoperative autologous donation ($690+/-$128; P < 0.001) or rHuEPO plus ANH ($1,393+/-$204, P < 0.001). CONCLUSIONS: All three blood-conservation strategies resulted in similar allogeneic blood exposure rates, but ANH was the least costly technique. Preoperative rHuEPO plus ANH prevented postoperative anemia but resulted in the highest transfusion costs.     

Acute normovolaemic haemodilution decreases postoperative allogeneic blood transfusion after total knee replacement

We hypothesized that the success of postoperative blood conservation after acute normovolaemic haemodilution (NVHD) is influenced by the extent of intraoperative bleeding and surgical trauma, and the timing of autologous blood transfusion. As total knee replacement is associated with minimal intraoperative but extensive postoperative blood loss, this procedure is ideally suited to acute NVHD. Therefore, to test our hypothesis, 30 patients undergoing elective total knee replacement were enrolled in a prospective, randomized, controlled study. In groups NVHD-2 and NVHD-6, before induction of anaesthesia patients were bled to a target packed cell volume (PCV) of 28-30%, and in the post-anaesthesia care unit autologous blood was transfused over a 2-h period terminating after operation at 2 and 6 h, respectively. In the control group, NVHD was not performed. After operation, platelets, fibrinogen, prothrombin and partial thromboplastin time, and liver function, urea and electrolytes were measured and compared with preoperative baseline values. Significantly (P < 0.024) more allogeneic blood was transfused in the control group (21 u.) compared with either group NVHD-2 (7 u.) or group NVHD-6 (5 u.). In the control group, despite the allogeneic blood transfusion, postoperative PCV decreased until day 4 after operation. Coagulation profile, liver function and urea and electrolytes concentrations were unaffected by the method of treatment. We conclude that for total knee replacement, acute NVHD is an effective blood conservation strategy. However, there was no difference in allogeneic blood administration between the two NVHD groups. Coagulation and liver function, and urea and electrolyte concentrations were unaffected by treatment.      

Effects of recombinant human erythropoietin on thrombosis and fibrinolysis in autologous transfusion for hip surgery

Recombinant human erythropoietin (rHuEPO) is effective in allowing autologous blood donation in patients unable to donate because of anemia. As adverse effects of rHuEPO might include activation of coagulation and possibly fibrinolysis, we investigated these possibilities in the context of autologous blood donation preceding hip surgery. Thirty-seven patients who donated 800 ml of autologous blood for elective hip surgery were randomly assigned to either a group of 20 receiving preoperative treatment with rHuEPO (erythropoietin beta), 6000 U i.v. twice weekly for 3 weeks, or an untreated control group of 17. A significant increase in platelet count was associated with autologous blood donation and intraoperative blood loss with or without rHuEPO. Coagulation and fibrinolysis were increased significantly by intraoperative blood loss in both groups, but not by rHuEPO. Coagulation and fibrinolysis were not activated by rHuEPO for elective hip surgery.     

Pre-operative injections of epoetin-alpha versus post-operative retransfusion of autologous shed blood in total hip and knee replacement: a prospective randomised clinical trial

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.     

Alternatives to allogeneic blood transfusions

Inherent risks and increasing costs of allogeneic transfusions underline the socioeconomic relevance of safe and effective alternatives to banked blood. The safety limits of a restrictive transfusion policy are given by a patient's individual tolerance of acute normovolaemic anaemia. latrogenic attempts to increase tolerance of anaemia are helpful in avoiding premature blood transfusions while at the same time maintaining adequate tissue oxygenation. Autologous transfusion techniques include preoperative autologous blood donation (PAD), acute normovolaemic haemodilution (ANH), and intraoperative cell salvage (ICS). The efficacy of PAD and ANH can be augmented by supplemental iron and/or erythropoietin. PAD is only cost-effective when based on a meticulous donation/transfusion plan calculated for the individual patient, and still carries the risk of mistransfusion (clerical error). In contrast, ANH has almost no risks and is more cost-effective. A significant reduction in allogeneic blood transfusions can also be achieved by ICS. Currently, some controversy regarding contraindications of ICS needs to be resolved. Artificial oxygen carriers based on perfluorocarbon (PFC) or haemoglobin (haemoglobin-based oxygen carriers, HBOCs) are attractive alternatives to allogeneic red blood cells. Nevertheless, to date no artificial oxygen carrier is available for routine clinical use, and further studies are needed to show the safety and efficacy of these substances.     

Erythropoetintherapie während häufiger Blutspenden Eine Dosisfindungsstudie

Avoidance of homologous blood products and patients' demand for preoperative autologous blood donation programs are increasing. As many of these patients are older, with a compromised cardiovascular system and a slow response of the erythropoietic system when anemia occurs, the feasibility and benefit of autologous blood donation is often limited. Augmentation of preoperative blood donation by therapy with recombinant human erythropoietin (rHuEPO) has been described in animal models and in patients. Methods. In a multicenter, controlled, randomized trial, 49 patients scheduled for orthopaedic or vascular surgery received 0 (control group, n=9), 200 (n=10), 300 (n=11), 400 (n=10) or 500 (n=9) U/kg rHuEPO (Erypo, Cilag, Sulzbach, distributor Fresenius, Oberursel, Germany) subcutaneously twice a week for 3 weeks while every week 450?ml blood was collected. Iron sulphate 100?mg was prescribed orally twice a day. Patients were ineligible if they had uncontrolled hypertension, recent myocardial infarction, haematological disorders or a history of seizures. Blood donation had to be cancelled if the haematocrit was below 30%. Results. There was a significant (ANOVA) drop of the haematocrit value only in the control group, and end-point values for haematocrit and haemoglobin were significantly elevated in the 400 and 500?U/kg groups compared with the control group (Table?9). Discussion. The erythropoietic stimulus of phlebotomy for autologous blood donations is often not efficient enough to guarantee a constant haematocrit. Lowering of the preoperative haematocrit jeopardizes the aim of avoidance of homologous blood transfusions. rHuEPO increased the efficiency of autologous blood collections, as predonation haematocrit values could be preserved in the high-dosage groups. As a consequence, homologous transfusions could be avoided. However, there were broad interindividual differences in the erythropoietic response, possibly due to limitations in iron availability. Adverse effects of rHuEPO therapy, such as hypertension, thrombosis or neurologic disorders, are mostly reported in patients with terminal kidney failure. No such disturbances were observed in the present study. Conclusion. rHuEPO ameliorates the preoperative decrease of haemoglobin and haematocrit values due to autologous blood donations in a dose-related fashion. The individually adjusted dosage of rHuEPO and iron supplementation merits further investigation.     

Place of normovolemic hemodilution in oncologic cervicofacial and ENT surgery

OBJECTIVE: Evaluate the use of normovolaemic haemodilution in cervico-facial oncologic surgery. STUDY DESIGN: Prospective, randomised, simple blinded study. PATIENTS AND METHODS: 38 ASA I and II patients were studied: a control group (n = 21) and a haemodilution group (n = 17) in whom 5.5-8 mL.kg-1 blood were withdrawn before induction, replaced by an equivalent amount of colloids. In both groups, the transfusional strategy was to keep the haemoglobin level above 100 g.L-1 throughout the procedure and the recovery phase, using in priority the autologous blood in the haemodilution group. Blood losses during surgery were evaluated by weighing the sponges and by measuring the aspirated blood. RESULTS: Demographic and anaesthetic data, and blood losses were similar. The haemoglobin levels dropped significantly in the haemodilution group (138 +/- 10 g.L-1 to 107 +/- 11 g.L-1) as well as in the control group (131 +/- 11 g.L-1 to 110 +/- 10 g.L-1). Infectious complications were slightly higher in the haemodilution group, although this difference did not reach the level of significance. CONCLUSION: Normovalaemic haemodilution does not seem to be indicated in cervico-facial and ENT oncologic surgery.     

急性高容性血液稀释联合自体血回收回输技术在全髋关节置换手术中的应用及对患者的影响

目的评价急性高容性血液稀释和自体血回收回输技术联合应用对全髋关节置换手术的血液保护效果及其安全性。方法 2010年9月至2012年3月在本组实施全髋关节置换手术、预计出血量〉600ml的120例患者随机分为四组,每组30例：对照组、急性高容性血液稀释组、自体血回输组、急性高容性血液稀释组＋自体血回收回输组。术中、术后对血流动力学指标、凝血功能进行检测,记录术中失血量、输血量,麻醉时间和手术时间,以及评价并发症。结果采用自体回输血技术的患者中约50%患者不用再输异体血,其中自体血回输组未输异体血的比例46.67%、急性高容性血液稀释组＋自体血回收回输组未输异体血比例为60%,而对照组中仅10%的患者不需输入异体血,单纯AHH组为1/3患者未输异体血。与对照组相比,所有采用血液保护措施的患者异体输血量比对照组约少240ml,自体血回输技术的再回收率约为40%;术中、术后各组血流动力学指标和凝血功能指标无明显差异,均保持维持稳定;各种组均未发现与应用血液保护技术有关的并发症。结论联合应用急性高容性血液稀释和自体血回收回输技术,可以明显减少失血量、降低异体输血,对患者影响小,并发症低,对全髋关节置换手术来说是一种安全有效的血液保护技术,值得推广应用。     

Consequences of acute normovolaemic haemodilution on haemostasis during major orthopaedic surgery

Acute preoperative normovolaemic haemodilution (NHD) is an accepted tool for reducing allogeneic blood transfusion requirements during surgery. At present, little is known of its impact on haemostasis. We have investigated the consequences of NHD on haemostasis by comparing conventional global tests (prothrombin time (PT), activated partial thromboplastin time (aPTT) with more specific measures of coagulation (prothrombin fragment 1 + 2 (F 1 + 2), thrombin-antithrombin III complex (TAT) and fibrinolysis (D-dimer (DD), plasmin-alpha 2- antiplasmin complex (PAP)). Blood samples were collected from two groups (NHD and controls) undergoing elective spinal surgery or pelvic osteotomy until day 3 after operation. The conventional global tests remained within normal limits: there were no significant differences between groups. Although surgery induced significant increases in the more specific measures of coagulation and fibrinolysis, there were no differences between NHD and control patients. Major orthopaedic surgery strongly activates coagulation and fibrinolysis. As the degree of these alterations was similar in haemodiluted and control patients, we suggest that acute preoperative normovolaemic haemodilution itself does not appear to be associated with greater perioperative disturbances in haemostasis.      

A Prospective Randomized Comparison of Three Blood Conservation Strategies for Radical Prostatectomy

Background: Preoperative autologous blood donation is a standard of care for elective surgical procedures requiring transfusion. The authors evaluated the efficacy of alternative blood-conservation strategies including preoperative recombinant human erythropoietin (rHuEPO) therapy and acute normovolemic hemodilution (ANH) in radical retropubic prostatectomy patients.

Methods: Seventy-nine patients were prospectively randomized to preoperative autologous donation (3 U autologous blood); rHuEPO plus ANH (preoperative subcutaneous administration of 600 U/kg rHuEPO at 21 and 14 days before surgery and 300 U/kg on day of surgery followed by ANH in the operating room); or ANH (blinded, placebo injections per the rHuEPO regimen listed previously). Transfusion outcomes, perioperative hematocrit levels, postoperative outcomes, and blood-conservation costs were compared among the three groups.

Results: Baseline hematocrit levels were similar in all groups (43% +/- 2%). On the day of surgery hematocrit decreased to 34% +/- 4% in the preoperative autologous donation group (P < 0.001), increased to 47% +/- 2% in the rHuEPO plus ANH group (P < 0.001), and remained unchanged at 43% +/- 2% in the ANH group. Allogeneic blood exposure was similar in all groups. The rHuEPO plus ANH group had significantly higher hematocrit levels compared with the other groups throughout the hospitalization (P < 0.001). Average transfusion costs were significantly lower for ANH ($194 +/- $192) compared with preoperative autologous donation ($690 +/- $128; P < 0.001) or rHuEPO plus ANH ($1,393 +/- $204, P < 0.001).     

Perioperative management of four anaemic female Jehovah's Witnesses undergoing urgent complex cardiac surgery

Previous studies have demonstrated that preoperative haemoglobinconcentration and female gender are related to an increasedneed for perioperative allogeneic transfusions in cardiac surgery.Hence, urgent cardiac surgery presents a dilemma for femalepatients who are Jehovah’s Witnesses, because of theirrefusal of allogeneic transfusion. This report describes themanagement of four high-risk anaemic female patients undergoingurgent complex cardiac surgery. In these Jehovah’s Witnesspatients, strict application of a comprehensive blood-sparingprotocol permitted safe avoidance of allogeneic transfusions.The protocol involved intraoperative acute normovolaemic haemodilution,intraoperative administration of tranexamic acid, intra- andpostoperative use of a cell-saver system, postoperative administrationof erythropoietin, iron and folic acid, and a careful surgicaltechnique to avoid perioperative bleeding.     

Autologous blood donation with recombinant human erythropoietin in anemic patients

BACKGROUND: Various blood management strategies can be used to reduce the need for allogeneic blood in cardiac surgery. In anemic patients, however, avoidance of allogeneic blood transfusion is difficult to achieve. This study was performed to assess the safety and effectiveness of preoperative blood collection using recombinant human erythropoietin (rHuEPO) for reducing the exposure to allogeneic blood in anemic patients. METHODS: Thirty-two anemic patients undergoing cardiac surgery at our hospital between January 1994 and October 1997 were divided into two groups according to preoperative strategies: 3-week treatment with rHuEPO and blood donation (group 1, n = 16) or iron supplementation alone (group 2, n = 16). RESULTS: There were no statistically significant differences between the two groups in patients' characteristics and surgical data. The number of reticulocytes was increased at just before surgery in group 1, whereas group 2 showed no significant increase. The estimated hemoglobin increases in group 1 were higher at 7 days and just before surgery. The mean number of required allogeneic blood for patients during surgery was 0.59 +/- 1.12 U in group 1 and 5.01 +/- 2.63 U in group 2. In 75% of group 1 patients, allogeneic blood transfusion was successfully avoided, whereas all patients in group 2 received allogeneic blood. CONCLUSIONS: This study suggests that the combination of rHuEPO administration and autologous blood donation can reduce the need for allogeneic blood in anemic patients.     

急性等容血液稀释在人工关节置换术中的应用

目的评价急性等容血液稀释在人工关节置换术围手术期的治疗效果以及异体血节约程度。方法回顾分析120例初次单侧人工关节置换术患者,对照组60例未进行自体血回输,实验组60例实施自体血回输,对比两组术前以及术后第2天的血红蛋白（Hb）、红细胞压积（Hct）、白蛋白（Alb）水平和术后2 d内录输注红细胞悬液和新鲜冰冻血浆的剂量。结果实验组与对照组在年龄、性别、手术类型间无统计学差异（t年龄=2.123,t性别=2.208,t手术类型=0.138,P均大于0.05）。实验组与对照组的术后Hb、术后Hct、术前Alb间无统计学差异（t术后Hb=-0.233,t术后Hct=0.310,t术前Alb=-1.698,P均大于0.05）。实验组术前Hb（140.58±13.92）g/L、术前Hct（40.43±3.83）高于对照组术前Hb（132.15±14.50）g/L、Hct（37.97±6.19）（t术前Hb=-3.251,t术前Hct=-2.626,P均小于0.05）。实验组术后Alb水平（32.70±2.05）g/L略低于对照组（33.80±3.11）g/L（t术前Alb=-1.698,t术后Alb=2.188,P均小于0.05）。实验组围手术期人均红细胞悬液和新鲜冰冻血浆使用量分别较对照组减少1.77 IU和2.45 IU（P〈0.001）。结论急性等容血液稀释自体血回输治疗在人工关节置换围手术期能够显著降低异体红细胞悬液和新鲜冰冻血浆的用量,同时不影响术后Hb以及Hct的水平。     

Limited, haemoglobin-dependent indication for autologous blood donation in total hip or knee replacement

AIM: The rejection rate of autologous blood donation before joint replacement is high. The influence of the haemoglobin value and the age of patient before autologous blood donation was examined according to the necessity for blood transfusion. METHOD: In a retrospective study, the data of 233 patients who had donated autologous blood before hip (THR) or knee arthroplasty (TKR) were analysed. RESULTS: 72 patients (30.9 %) received an autologous blood transfusion during surgery or in the further course until the first day after surgery. A multivariate analysis showed no significant influence of age on the need for transfusions (p = 0.093), but a higher haemoglobin value before blood donation reduced the risk significantly to 0.712 per unit (1 g/dl). Therefore the age of the patient was less predictive compared to the haemoglobin value as to whether or not a blood transfusion had been necessary. CONCLUSION: The high security of homologous blood reached in the last years and the knowledge that autologous blood donation reduces the haemoglobin value before surgery has led to the procedure in our hospital only to perform autologous blood donation at the explicit request of the patient.     

Efficacy of postoperative blood salvage following total hip arthroplasty in patients with and without deposited autologous units

BACKGROUND: Patients undergoing total hip replacement routinely receive perioperative blood transfusions, increasing their risk of blood-borne disease, isoimmunization, anaphylactic reaction, and hemolytic reaction. The purpose of this retrospective, case-control study was to evaluate the effect of postoperative blood salvage on the need for allogeneic transfusion following total hip replacement. METHODS: We reviewed the medical records of ninety consecutive patients who, during a twelve-month period, had undergone unilateral, elective total hip replacement that included use of a postoperative blood salvage device. For comparison, we reviewed the medical records of ninety consecutive patients who had undergone total hip replacement without postoperative blood salvage. Overall, 156 patients had complete medical records and were included in the study. RESULTS: Eight (10 percent) of the patients who had been treated with a drain and seventeen (23 percent) of the patients who had been treated without a drain received allogeneic transfusions. Of the nineteen patients who had not deposited autologous blood, all six without postoperative blood salvage required allogeneic transfusion. With control for other variables in the model, regression analysis showed a significantly increased risk of allogeneic transfusion among patients who had undergone total hip replacement without postoperative blood salvage (p = 0.0028) and without having predonated autologous units (p = 0.0001). CONCLUSIONS: Despite a limited sample size, the study results showed that postoperative blood salvage significantly reduced the risk of allogeneic transfusion among patients managed with total hip replacement, whether or not they had deposited autologous blood (p < 0.0001). With control for donated units, age, gender, preoperative hematocrit, intraoperative blood loss, and cementless technique, patients who were treated without postoperative blood salvage were approximately ten times more likely to require allogeneic transfusion than were patients who had a drain.     

Postoperative Inflammatory Response after Autologous and Allogeneic Blood Transfusion

Background: Allogeneic blood transfusions cause immunosuppression. The aim of this study was to determine whether complement anaphylatoxins, cytokines, or both are released in the recipient, after blood transfusions in general, and after autologous blood transfusions in particular.

Methods: Thirty-one patients having total hip joint replacement surgery were randomized to receive either allogeneic red blood cells (n = 15) or predeposited autologous whole blood transfusion (n = 16). Plasma concentrations of the anaphylatoxins C3a and C5a, the terminal C5b-9 complement complex, and cytokines IL-6 and IL-8 in the recipients were repeatedly analyzed before, during, and after surgery.

Results: Significantly increased concentrations of IL-6 and IL-8 appeared in both groups, with a significantly greater increase in the autologous blood group. Patients in both groups developed a moderate but significant increase of C3a without a significant difference between them. C5a and terminal C5b-9 complement complex were not greatly changed.