Safety of retransfusion of filtered shed blood in 1819 patients after total hip or knee arthroplasty

Abstract

SUMMARY Autologous retransfusion of filtered drained blood is widely used after total hip (THA) and knee arthroplasty (TKA) in many countries. Despite its wide use, prospective studies on clinical side effects with a substantial number of patients have not been published. In this prospective clinical trial, 1819 consecutive patients in 38 hospitals were retransfused using a low-suction drainage autologous blood transfusion system, after THA (n = 995) or TKA (n = 824). The occurrence of adverse events during retransfusion of the filtered shed blood was studied. An average of 460 mL of drained blood (THA, 374 mL; TKA, 563 mL) was retransfused within 6 hours postoperatively. The frequency of serious adverse events was 0.1%, which concerned two patients: one had a short asystole during reinfusion that responded quickly to medication; and the other with a history of deep vein thrombosis had pulmonary embolism. By way of non-serious adverse events, febrile reactions (fever, shivering) were observed in 3.1% of the patients during retransfusion. Clot formation was observed in the drained blood in six (0.3%) patients; therefore, retransfusion was not carried out. These minor adverse events were seen more often after TKA (5.8%) than after THA (1.5%). Nine (0.5%) patients were retransfused with volumes above 1500 mL (average 1657, range 1550–1900), without adverse events. Additional allogenic blood transfusions were required by 18% of the THA and 9% of the TKA patients. In this study, few adverse events were detected during retransfusion. The frequency of serious (0.1%) and minor (3.5%) adverse events was similar to other smaller clinical studies. Based on the low incidence of side effects in this large cohort of orthopedic patients, postoperative cell salvage with such a retransfusion system is considered to be safe.