Preoperative treatment with recombinant human erythropoietin or predeposit of autologous blood in women undergoing primary hip replacement

BACKGROUND: Controversy exists about the advantages of predeposit of autologous blood (PDAB), and whether more comfortable blood conservation regimens may yield comparable results. To test the hypothesis that preoperative treatment with recombinant human erythropoietin (rHuEPO) with or without acute concomitant normovolaemic haemodilution (ANHD) is as effective as PDAB in reducing allogeneic blood transfusions, we conducted a prospective randomised study in women undergoing primary hip replacement. METHODS: Sixty consecutive female patients scheduled for primary hip replacement and suitable for PDAB were randomly assigned to one of 3 groups. Group I (EPO) and II (ANHD) received 600 U/kg rHuEPO s.c. and 100 mg iron saccharate i.v. on day 14 and, if needed, on day 7 before surgery. Additionally, in group II acute normovolaemic haemodilution (ANHD) was implemented after induction of anaesthesia. In group III (PDAB) conventional PDAB up to 3 U, without volume replacement but with concomitant oral iron therapy, was performed starting 4 weeks before surgery. RESULTS: The blood conservation methods resulted in a comparable net gain of red cells in all 3 groups until the day of surgery. Because of the withdrawal of autologous blood, haemoglobin values before surgery were lower in the PDAB group than in the EPO and ANHD groups, and during surgery were lower in the PDAB and ANHD groups than in the rHuEPO-only group. Applying moderate ANHD in conjunction with preoperative rHuEPO treatment did not yield an incremental decrease in allogeneic transfusions. There was no difference between the groups in the number of patients who received allogeneic transfusions or in the total number of allogeneic units transfused. CONCLUSIONS: Withdrawal of autologous blood is associated with lower pre- and intraoperative haemoglobin levels when compared to preoperative augmentation of red cell mass using rHu-EPO. As a measure to reduce allogeneic transfusion requirements, preoperative treatment with rHuEPO may be as effective as standard predeposit of autologous blood in women undergoing primary hip replacement, but requires less preoperative time.     

Effect of recombinant human erythropoietin on autologous blood pre-donation in open heart surgery

We have used recombinant human erythropoietin (EPO) with an autologous blood predonation in open heart surgery looking forward to preventing patient's blood level of hemoglobin and quick recovery in post-operative period. In our results, patient's value of hemoglobin (Hb) and hematocrit (Ht) decreased due to autologous blood predonation. In group A (autologous blood predonation with EPO administration), however, predonated blood volume were larger than in group B (without EPO administration), decreased value of Hb and Ht were smaller than in group B. The counts of reticulocyte were higher in group A at the operative day. Among six cases phlebotomized with EPO administration, five cases required no homologous blood transfusion for their hospital course. Postoperative recovery of patient's Ht value were earlier in preoperative blood donation group. In particular, patients who administered EPO intravenously have showed fair recovery from anemia. EPO is very effective drug to prevent patients from the developing anemia as a complication of autologous blood predonation. We conclude that autologous blood predonation with EPO administration is beneficial method to reduce homologous blood requirement in open heart surgery.     

Autologous blood transfusion in patients with hepatocellular carcinoma undergoing hepatectomy

BACKGROUND: Homologous blood transfusion (HBT) has the risk of an immunosuppressive effect and may adversely affect the prognosis of patients with carcinomas. Autologous blood transfusion (ABT) has not yet become a standard procedure in gastroenteric cancer surgery. We investigated the usefulness and problems of ABT combined with the use of recombinant human erythropoietin (rh-EPO). METHODS: An evaluation of autologous blood transfusion (ABT) combined with recombinant human erythropoietin (rh-EPO) treatment was conducted in 46 patients with hepatocellular carcinoma undergoing hepatectomy. Preoperative autologous blood donation (ABD) was accomplished for 25 of the 46 patients. The preoperative changes in hemoglobin and hematocrit in relation to route of administration of erythropoietin were studied. In addition, intraoperative blood requirements and the postoperative complications for patients who predonated were compared with those of patients who underwent surgery without autologous predonation. RESULTS: The proportion of patients not requiring additional homologous blood transfusions (HBT) during operation was significantly higher in the ABD group than in the non-ABD group (88% versus 38%). The incidence of postoperative complications was significantly higher in patients receiving HBT than in nontransfused patients and in those receiving ABT. CONCLUSIONS: Preoperative autologous blood donation in combination with rh-EPO therapy markedly reduced the requirement for homologous blood transfusion during surgery in patients with hepatocellular carcinoma having hepatectomy.     

Bloodless surgery in a patient with thalassemia minor. Usefulness of erythropoietin, preoperative blood donation and intraoperative blood salvage

A patient with thalassemia minor and idiopathic scoliosis was scheduled for posterior vertebral arthrodesis. The diagnosis of thalassemia minor was made during the preoperative assessment. Preoperative blood cell count displayed the following data: red blood count 5.4 x 106/microL, haemoglobin 11.6 g/dL and hematocrit 36.9%. As corrective surgery for scoliosis is associated with major blood loss, the patient was scheduled for preoperative treatment with human recombinant erythropoietin (rHuEPO), autologous blood donation, intraoperative blood cell salvage and administration of tranexamic acid. The use of rHuEPO was intended to increase hemoglobin (12.1 g/dL) levels at the moment of surgery following the donation of 2 autologous blood units. 1000 mL of salvaged blood were processed. The output line of the blood cell salvage machine did not show any sign of increased red cell haemolysis. The postoperative course was uneventful and the patient was discharged from the postoperative intensive care unit on day 7 after surgery with no allogenic blood transfusion. No references detailing the use of rHuEPO and autologous blood donation preoperatively in patients with thalassemia minor and only one case report discussed the utility of intraoperative blood cell salvage in a patient with thalassemia intermedia. Although further experience is needed, this case report suggests that even for patients with thalassemia minor, methods focused on allogenic blood salvage can be used safely.     

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.     

Erythropoietin alone or as an adjuvant for the autologous blood donation program in major orthopedic surgery

BACKGROUND: Patients with anemia undergoing elective joint replacement are often excluded from preoperative autologous donation (PAD). The purpose of this study was to compare the efficacy of preoperative erythropoietin (epoetin alpha) as an adjuvant treatment to PAD versus preoperative erythropoietin alfa alone in patients with mild anemia undergoing major orthopedic surgery. PATIENTS AND METHODS: The study enrolled 75 patients scheduled for total joint arthropalsty of the hip or knee or spinal surgery and with a hemoglobin (Hb) concentration between 10 and 13 g/dL. Group 1 patients were assigned to receive weekly doses of subcutaneous epoetin alpha (40,000 IU) 21, 14, and 7 days before surgery and to participate in the PAD program; group 2 patients were excluded from the PAD program and received 2 doses of epoetin alpha every week over the same period. RESULTS: Group 1 (n = 39) and group 2 (n = 36) were similar with respect to patient characteristics, biological parameters, and surgical procedures, In group 1, mean preoperative Hb rose fom 12.5 g/dL to 12.8 g/dL, patients received a mean 5.1 doses of epoetin alpha, and they gave a mean 1.9 units of autologus blood and 1 received allogenic blood. In group 30.7% received transfusions of autologous blood and 1 received allogenic blood. In group 2, preoperative Hb increased from 11.7 g/dL to 13.5 g/dL, patients received 3.8 doses of epoetin alpha, and 3 were transfused with allogenic blood (P > 0.05). CONCLUSION: Epoetin alpha alone and erythropoietin as a adjuvant to a PAD program are equally effective in reducing allogenic transfusion during hip and knee arthroplasty and spinal column surgery of up to 3 spaces.     

Erythropoietin for autologous blood donation in total hip arthroplasty patients

Forty patients who were scheduled for a total hip arthroplasty were enrolled in a prospective study and were randomly divided into two groups. Group 1 received recombinant human erythropoietin (300 U/kg twice a week), and group 2 received placebo. The medication was started 2 weeks before the operation, and only one dose of medication was given after the operation. Autologous blood was administered at the same time as the medication until the hemoglobin level sank to 10 g/dl. Forty-eight and 49 units of autologous blood were collected in group 1 and group 2, respectively. Intraoperative homologous blood was transfused only to patients in group 2. Seven and 13 units of allogenic blood were transfused into group 1 and group 2 patients during the postoperative period, respectively. There were no any significant differences between the groups in terms of early postoperative hemoglobin level and amount of autologous blood collected. However, the increase of the reticulocyte count in patients who received erythropoietin was significantly higher than in the group 2 patients. The study showed that short-term and low-dose erythropoietin usage strongly stimulates the bone marrow. Erythropoietin administration and preoperative autologous blood donation diminished the total units of allogenic blood required during the intraoperative or postoperative pe-riod. Autologous blood administration without concurrent erythropoietin did not stimulate the bone marrow adequately. Received: 13 January 2000     

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).     

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.     

A randomized, parallel-group, open-label trial of recombinant human erythropoietin vs preoperative autologous donation in primary total joint arthroplasty: effect on postoperative vigor and handgrip strength

This randomized trial assessed the effect of recombinant human erythropoietin (EPO) vs preoperative autologous donation (PAD) on postoperative vigor and handgrip strength in patients undergoing primary total joint arthroplasty. Adults with baseline hemoglobin level of 11 to 14 g/dL received EPO (600 IU/kg once weekly for 4 doses, n = 130) or PAD (n = 121) before primary, unilateral hip or knee arthroplasty. Mean changes in vigor score and handgrip strength from baseline were not significantly different between treatment groups. Multivariate analyses found a significant treatment effect favoring EPO over PAD for vigor, but not for handgrip strength. Patients in the EPO group had higher hemoglobin levels and required fewer transfusions. Both treatments were well tolerated. Additional study is needed to elucidate the influence of blood management strategies on postoperative vigor.     

Preoperative use of recombinant human erythropoietin before total joint arthroplasty

BACKGROUND: Previous reports have suggested that the use of recombinant human erythropoietin is effective for decreasing the need for perioperative allogeneic blood transfusion. The purpose of this study was to evaluate the efficacy of erythropoietin in combination with, and compared with, preoperative autologous donation for reducing allogeneic blood requirements for total joint arthroplasty. METHODS: Two hundred and forty patients undergoing primary and revision total hip or knee arthroplasty were enrolled into three groups with different treatment regimens: (1) erythropoietin and preoperative autologous donation (Group 1), (2) erythropoietin alone (Group 2), and (3) preoperative autologous donation alone (Group 3). Patients were evaluated with regard to requirements for allogeneic transfusion, change from the baseline to the lowest postoperative hemoglobin value, postoperative complications, and adverse reactions. RESULTS: The rate of allogeneic transfusion was 11% in Group 1 (erythropoietin and preoperative autologous donation) compared with 28% in Group 2 (erythropoietin alone) and 33% in Group 3 (preoperative autologous donation alone). Within Group 1, patients who had a unilateral primary arthroplasty had an allogeneic transfusion rate of 4% and those who had a bilateral or revision arthroplasty had an allogeneic transfusion rate of 17%. In Groups 2 and 3, the allogeneic transfusion rates were 14% and 15%, respectively, for the patients who had a unilateral primary arthroplasty and 35% and 47%, respectively, for those who had a bilateral or revision arthroplasty. CONCLUSIONS: Preoperative use of erythropoietin in conjunction with preoperative autologous donation reduces the need for allogeneic blood transfusion associated with total joint arthroplasty more effectively than does either erythropoietin or preoperative autologous donation alone.     

Nonanemic Patients Do Not Benefit from Autologous Blood Donation Before Total Knee Replacement

A retrospective analysis of 221 patients undergoing unilateral total knee arthroplasty between January 2007 and April 2008 was performed to look at rates of total transfusions, allogenic transfusions, and autogenic transfusions. Two senior surgeons performed all the surgeries. During that period, patients in group A (129 patients) all donated one unit of autologous blood and patients in group B (92 patients) did not donate. Within both groups, patients were further divided by preoperative hemoglobin level as either anemic or non-anemic. A hemoglobin of 12.5 g/dL was used as the cutoff. Ninety-eight patients in group A (76%) required autologous blood. Patients in group A received a higher total number of transfusions (0.93 per patient) than those in group B (0.33 per patient; p < 0.001). The rate of allogenic transfusion was lower for group A (14%) than for group B (25%; p < 0.033). The reduction of allogenic transfusions associated with preoperative autologous blood donation was confined to anemic patients (29% in group A vs 72% in group B; p = 0.0006). There was no difference in allogenic blood transfusions in non-anemic patients between group A (8%) and group B (9%; p = 0.91). Limiting autologous blood donation to anemic patients decreased cost compared to routine autologous blood donation (US 256.63/patient versus US256.63/patient versus US 511.44/patient) without exposing patients to increased allogenic blood transfusions. Targeted blood management in total knee replacement surgery decreases transfusion rates and reduces cost.     

Comparison of intravenous and subcutaneous erythropoietin therapy for preoperative acquisition of blood for autologous transfusion in patients undergoing total arthroplasty

Before undergoing total arthroplasty, 120 patients agreed to provide their own blood for autologous transfusion. Recombinant human erythropoietin (EPO) was given intravenously to 30 patients (group I), and subcutaneously to 40 (group S); 50 patients (group N) were not given EPO. Fifteen of the 120 patients (group I,n=3; group S,n=3; group N,n=9) required homologous blood transfusion because their hemoglobin levels fell below 7.0g/dl or their vital signs changed after surgery. The hemoglobin recovery rates (HRRs) of groups I, S, and N increased by 22.8%, 47.2%, and 11.8% respectively, compared to estimated hemoglobin rates. The HRRs per 10000 IU EPO increased by 4.7% and 3.6%, respectively, in groups S and I. Groups I and S lost less blood, in total, during and after surgery than group N. Five of the 70 patients in groups I and S combined did not respond to EPO, but no patients treated with EPO experienced any side effects prior to the surgery. During the trial, one woman, who underwent total hip arthroplasty, developed a pulmonary embolism on the 10th postoperative day. Platelet counts and plasminogen activator inhibitor-1 antigen levels in all groups increased after blood donation, with values in the EPO-treated groups being higher than those in group N. Treatment with EPO makes more feasible the donation of their own blood for autologous transfusion in patients about to undergo total arthroplasty.     

Predictors of allogenic blood transfusion in elective cardiac surgery after preoperative autologous blood donation

Purpose  Preoperative autologous blood donation (PAD) is important for reducing exposure to allogenic blood in cardiac surgery. Unfortunately, even after PAD, allogenic blood transfusion is not always avoided. We investigated the predictors of blood component usage during elective cardiac surgery in patients prepared with PAD. Methods  Clinical data were collected for 143 consecutive patients (103 men and 40 women; mean age, 62 ± 9 years) who underwent elective cardiac surgery after PAD (959 ± 240 ml), often using iron supplement and recombinant human erythropoietin. Results  Allogenic blood transfusion was avoided during and after surgery in 107 patients (75%), whereas 36 patients required an allogenic transfusion (4.1 ± 3.8 U of packed red cells, 3.4 ± 4.1 U of fresh frozen plasma, and 5.8 ± 11.0 U of platelet concentrate). The independent factors for perioperative allogenic blood transfusion in these patients included the pre-donation hemoglobin value, the preoperative platelet count, and the lowest hemoglobin value during cardiopulmonary bypass. Conclusion  Even with PAD for elective cardiac surgery, patients whose pre-donation hemoglobin value and preoperative platelet count are low may require allogenic blood transfusion.     

Recombinant human erythropoietin therapy for autologous blood donation in rheumatoid arthritis patients undergoing total hip or knee arthroplasty

The effect of recombinant human erythropoietin on autologous blood donation was investigated in 73 rheumatoid arthritis patients who underwent hip or knee arthroplasty. Autologous blood donation of 400 mL was successful with recombinant human erythropoietin (12,000 U per week), and no homologous blood was required. The mean period of blood collection was 33.8 days. Mean hemoglobin levels were 9.7 g/dL before treatment, 10.7 g/dL before surgery, and 10.2 g/dL after surgery. This study confirmed recombinant human erythropoietin is effective for enabling preoperative blood donation in rheumatoid arthritis patients.     

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.     

Does the Use of Erythropoietin Reduce the Risk of Exposure to Allogeneic Blood Transfusion in Cardiac Surgery? A Systematic Review and Meta‐Analysis

BACKGROUND: The use of blood conservation techniques is important in cardiac surgery as postoperative bleeding is common and allogeneic blood transfusion carries the risk of transfusion reactions and infection transmission. Erythropoietin with and without preoperative autologous blood donation is one of the modalities to avoid allogeneic blood transfusion. The objective of this review was to assess the effectiveness of erythropoietin in reducing the risk of exposure to allogeneic blood transfusion during or after cardiac surgery. METHODS: A meta-analysis of 11 identified randomized controlled trials, reporting comparisons between erythropoietin and control, was undertaken. The primary outcome was the number of patients exposed to allogeneic blood transfusion during or after cardiac surgery. RESULTS: Eleven studies, involving 708 patients, met the inclusion criteria for this review. In total, 471 patients were given erythropoietin, and 237 patients formed the control group. The administration of erythropoietin with and without preoperative autologous blood transfusion prior to cardiac surgery is associated with a significant risk reduction: RR = 0.28 (95% CI 0.18-0.44, P < 0.001) and RR = 0.53 (95% CI 0.32-0.88, P < 0.01), respectively. CONCLUSION: The administration of erythropoietin before cardiac surgery is associated with a significant reduction in the risk of exposure to allogeneic blood transfusion. Further studies are warranted to define the patients' subgroups that may benefit the most from EPO administration.     

Effectiveness of postoperative autologous blood transfusion after knee replacement surgery and influence of preoperative hemoglobin level

OBJECTIVE: To evaluate the effectiveness of postoperative autologous blood transfusion on reducing the need for allogenic transfusion during recovery from total knee arthroplasty until hospital discharge, and to determine whether effectiveness is related to preoperative hemoglobin level. MATERIAL AND METHODS: Retrospective study of patients undergoing surgery at Hospital Jerez de la Frontera, Spain, in 2003, assessing the association between postoperative autologous blood transfusion, preoperative hemoglobin, and allogenic transfusion requirements. RESULTS: A total of 107 patients were studied. Eighty-three received autologous blood transfusions after surgery and 15 (14.02%) required allogenic transfusion. The rate of allogenic transfusion was higher in association with hemoglobin levels exceeding 13 g x dL(-1) (P=0.003) and it was lower in patients who received autologous blood transfusions (P=0.046). In patients who received autologous transfusion, preoperative hemoglobin level and risk of allogenic transfusion were unrelated. When autologous transfusion was not given, allogenic transfusion risk was higher when hemoglobin concentration was less than 13 g x dL(-1) (P=0.0008). Autologous transfusion had a significant effect when hemoglobin level was less than 13 g x dL(-1) (P=0.002) but did not affect the rate of transfusion when hemoglobin was 13 g x dL(-1) or more. CONCLUSIONS: Autologous blood transfusion is effective for reducing the need for allogenic transfusion after knee replacement surgery, particulary when a patient's hemoglobin level is less than 13 g x dL(-1).     

Minimal effective dosage of recombinant human erythropoietin in spinal surgery

Preoperative autologous blood donation is one of the most widely used methods of autotransfusion. However securing a predetermined amount of blood (3 units of whole blood) may be difficult in patients with a low preoperative hematocrit. To determine the minimum effective pretreatment dosage of recombinant human erythropoietin required to secure an adequate amount of preoperative blood for autologous transfusion during posterior decompression and instrumentation fusion using the pedicle screw-rod system in the lumbar spine, a prospective randomized clinical trial was done. Forty-five patients who had a preoperative hematocrit less than 40% were selected and were divided blindly into three groups. Fifty units per kilogram of recombinant human erythropoietin seems to be the minimal effective dosage for securing an adequate amount of preoperative autologous blood donation.     

Who needs autologous blood donation in joint replacement?

Conflicting results are available about the efficacy of routine preoperative autologous donation (PAD) in reducing allogenic blood transfusion during total joint arthroplasty (TJA). This study aimed to determine if PAD is effective in reducing the need for allogenic transfusion after TJA. For this retrospective study, data on 409 patients who received total knee arthroplasty (TKA) and 513 who underwent total hip arthroplasty (THA) from January to June 2005 were evaluated. It is our institutional policy to offer preoperative donation to all patients. Based on patient decision, preoperative hemoglobin, and other factors, PAD may or may not take place. Five hundred forty-six (61%) patients donated on average 1.3 units (range, 1 to 2) of blood. Autologous and allogenic transfusions were respectively performed in 91% (514 patients) and 24% of our cohort. The rate of allogenic transfusion after TKA was lower in the PAD group at 21% versus 27% among the nondonors, although it was not statistically significant (p = 0.10). The allogenic transfusion rate after THA was significantly lower among autologous donors (16% versus 34%, p = 0.003). Advanced age, lower body mass index, simultaneous bilateral arthroplasty, and lower preoperative hemoglobin were independently associated with increased allogenic blood transfusion. PAD seems to be effective in reducing allogenic transfusions after THA but not TKA.