Targeted pre-operative autologous blood donation: a prospective study of two thousand and three hundred and fifty total hip arthroplasties.

Abstract

Pre-operative donation of autologous blood has been widely used in elective joint replacement procedures to avoid the risks of allogeneic blood transfusions. However, the high percentage of wasted autologous blood questions the general efficacy of pre-operative autologous blood donation (PABD) for all patients undergoing hip replacement. This study prospectively investigates the impact of a targeted pre-operative autologous blood donation protocol for anaemic patients on allogeneic and overall transfusion rates in 2,350 unilateral primary total hip arthroplasty procedures. Patients with pre-operative haemoglobin less than 12.5 g/dL were advised to donate one unit of autologous blood seven to 15 days prior to the date of surgery. The targeted protocol was followed by 2,251 patients: 280 out of 367 anaemic patients donated while 1,971 out of 1,983 non-anaemic patients did not donate. Results showed a significantly lower rate of allogeneic transfusion for anaemic patients who predonated than anaemic patients who did not (13 % vs. 37% respectively, p < 0.001). Overall transfusion rates for patients who followed the protocol (n = 2,251) were found to be 0.17 units/patient compared to previously reported numbers of 0.75 units/patient when routine donation was used. Among the 2,251 patients who followed the protocol, only 140 patients (6%) had their autologous blood wasted, in contrast to values reported in the literature ranging from 14% up to 50%. Targeted PABD reduces the need for allogeneic blood transfusion in anaemic patients and significantly reduces the overall number of transfusions compared to routine pre-operative autologous donation.