Incidence Of Allogeneic Blood Transfusion Research Articles

Efficacy of Intravenous Tranexamic Acid on Perioperative Blood Loss and Transfusion Requirement in Spine Fusion Surgery

Introduction: Blood loss associated with spine fusion surgery is a common potential cause of morbidity and often requires a blood transfusion, which subjects patients to risks of blood transfusion. Tranexamic acid is used intra-operatively to reduce bleeding in major surgeries. This study aims to evaluate its efficacy on perioperative blood loss and transfusion requirement in patients undergoing spine fusion surgery
 Methods: This prospective randomised controlled study was conducted at Department of Orthopedics of Tribhuvan University Teaching Hospital between August 2015 and July 2016. Patients undergoing spine fusion surgery were randomly assigned to group A (TXA) and group B (control) equally, thirty patients in each group. TXA was given to group A in a loading dose of 10 mg/kg, followed by continuous infusion of 1 mg/kg/hr during surgery. Outcome measures included perioperative blood loss, amount of blood transfusion, and safety and adverse effects. The data were analyzed by means of SPSS version 21.0. The results were presented as mean ± SD. Differences were considered significant if the P-value was <0.05.
 Results: Sixty patients (31 males, 29 females) with mean age of 39.95 years were enrolled in study, thirty patients in each group. Statistical analysis showed no significant differences between the 2 study groups with regard to age, sex, weight, preoperative hemoglobin, level of fusion as well as operative time. The amount of perioperative blood loss was significantly less in the group A versus group B, 241.274±162.819 ml vs 661.053±189.469 ml, p=0.000. There was no difference in the incidence of allogenic blood transfusion. There were no complications related to use of TXA in this study.
 Conclusion: TXA provided an effective and safe method for reduction of blood loss during and after spine fusion surgery. However, there was no difference in the incidence of perioperative allogeneic blood transfusion.

Combination effect of intraoperative and postoperative intravenous tranexamic acid in hip hemiarthroplasty. A propensity score matched analysis

BackgroundTranexamic acid (TXA) has been proven to reduce perioperative blood loss and the incidence of allogeneic blood transfusion in total joint arthroplasty (TJA). However, there is limited literature on the use of TXA in patients undergoing hip hemiarthroplasty. Furthermore, combination effect of intraoperative and postoperative intravenous TXA has not been investigated extensively. The purpose of this study was to evaluate this combination effect on hip hemiarthroplasty by a propensity score matched analysis (PSMA). MethodsThis is a retrospective cohort study involving hip hemiarthroplasty for femoral neck fracture. All patients received 1g intraoperative intravenous TXA. One group also received 1g intravenous TXA 6h after surgery, while the other group did not. Perioperative blood loss, the incidence of allogeneic blood transfusion and venous thromboembolism (VTE) were collected and compared. Results209 patients who underwent unilateral hip hemiarthroplasty were included. PSMA resulted in 66 matched pairs in each group. There were no significant differences in perioperative blood loss on postoperative day (POD) # 1, 3, 5 (637.2 ± 285.9 versus 653.6 ± 305.5, 726.6 ± 274.2 versus 676.3 ± 313.2, 795.5 ± 291.2 versus 759.9 ± 328.4), the incidence of allogeneic blood transfusion (9.1% versus 12.1%) and VTE (1.5% versus 1.5%) between the two groups (P value> 05) for up to one year. ConclusionIntraoperative and postoperative intravenous TXA have no combination effect on reducing perioperative blood loss, the incidence of allogeneic blood transfusion and VTE in patients undergoing hip hemiarthroplasty.

VISCOELASTIC TESTING IN CARDIAC SURGERY

TYPE: Late Breaking Abstract TOPIC: Cardiothoracic Surgery PURPOSE: Viscoelastic tests (rotational thromboelastometry, ROTEM®), together with the implementation of a specific algorithm for coagulation management in cardiac surgery, enable perioperative coagulopathy to be better controlled. METHODS: Retrospective cohort study including 675 patients who underwent cardiac surgery with cardiopulmonary bypass. The incidence of allogeneic blood transfusions and clinical postoperative complications were analyzed before and after ROTEM® implementation. RESULTS: Following viscoelastic testing and the implementation of a specific algorithm for coagulation management, the incidence of any allogeneic blood transfusion decreased (41.4% vs 31.9%, p=0.026) during the perioperative period. In the group monitored with ROTEM®, decreased incidence of transfusion was observed for packed red blood cells (31.3% vs 19.8%, p=0.002), fresh frozen plasma (9.8% vs 3.8%, p=0.008), prothrombin complex concentrate administration (0.9% vs 0.3%, p=0.599) and activated recombinant factor VII (0.3% vs 0.0%, p=0.603). In addition, statistically significant reductions were detected in the incidence of postoperative bleeding (9.5% vs 5.3%, p=0.037), surgical reexploration (6.0% vs 2.9%, p=0.035), and length of Intensive Care Unit (ICU) stay (6.0 days vs 5.3 days, p=0.026). CONCLUSIONS: The monitoring of hemostasis by ROTEM® in cardiac surgery, was associated with decreased incidence of allogeneic blood transfusion, clinical hematologic postoperative complications and lengths of ICU stay. CLINICAL IMPLICATIONS: Finally, the data of this retrospective study have shown that implementation of the ROTEM® system, together with a specific algorithm to interpret its results, was associated with a significant decrease in the incidence of any blood product transfusion, as well as decreased incidence of postoperative bleeding, unplanned reexploration and lengths of ICU stay. DISCLOSURE: Nothing to declare. KEYWORD: Cardiac surgery

Evaluation of health outcomes after the implementation of rotational thromboelastometry in patients undergoing cardiac surgery

Background Viscoelastic tests (rotational thromboelastometry, ROTEM®), together with the implementation of a specific algorithm for coagulation management in cardiac surgery, enable perioperative coagulopathy to be better controlled. Methods Retrospective cohort study including 675 patients who underwent cardiac surgery with cardiopulmonary bypass. The incidence of allogeneic blood transfusions and clinical postoperative complications were analyzed before and after ROTEM® implementation. Results Following viscoelastic testing and the implementation of a specific algorithm for coagulation management, the incidence of any allogeneic blood transfusion decreased (41.4% vs 31.9%, p = .026) during the perioperative period. In the group monitored with ROTEM®, decreased incidence of transfusion was observed for packed red blood cells (31.3% vs 19.8%, p = .002), fresh frozen plasma (9.8% vs 3.8%, p = .008), prothrombin complex concentrate administration (0.9% vs 0.3%, p = .599) and activated recombinant factor VII (0.3% vs 0.0%, p = .603). Increased incidence was observed for platelet transfusion (4.8% vs 6.8%, p = .530) and fibrinogen concentrate (0.9% vs 3.5%, p = .066), tranexamic acid (0.0% vs 0.6%, p = .370) and protamine administration (0.6% vs 0.9%, p = .908). Similar results were observed in the postoperative period, but with a decreased incidence of platelet transfusion (4.8% vs 3.8%, p = .813). In addition, statistically significant reductions were detected in the incidence of postoperative bleeding (9.5% vs 5.3%, p = .037), surgical reexploration (6.0% vs 2.9%, p = .035), and length of Intensive Care Unit (ICU) stay (6.0 days vs 5.3 days, p = .026). Conclusions The monitoring of hemostasis by ROTEM® in cardiac surgery, was associated with decreased incidence of allogeneic blood transfusion, clinical hematologic postoperative complications and lengths of ICU stay.

POST-OPERATIVE COMPLICATIONS IN CARDIAC SURGERY PATIENTS

TOPIC: Cardiothoracic Surgery TYPE: Original Investigations PURPOSE: Perioperative coagulopathy and postoperative bleeding are the most common complications in patients undergoing cardiac surgery, especially when the cardiovascular surgery is associated with cardiopulmonary bypass (CPB). In this context, some studies suggest that implementation of viscoelastic point-of-care tests (POCT), such as rotational thrombo-elastometry, in conjunction with a specific algorithm for coagulation management in cardiac surgery, allow for better control of hemostatic pathology. METHODS: Retrospective cohort study including 675 patients who underwent cardiac surgery with cardiopulmonary bypass. This first group (N=336) is characterized by having received perioperative transfusion therapy based on conventional laboratory coagulation tests and clinical judgment. This second group (n=339) is characterized by having received perioperative transfusion therapy based on the results of the ROTEM® viscoelastic point-of-care test system and a specific coagulation management algorithm. RESULTS: Following viscoelastic testing and the implementation, the incidence of any allogeneic blood transfusion decreased (41.4% vs 31.9%, p=0.026) during the perioperative period. In the group monitored with ROTEM®, decreased incidence of transfusion was observed for packed red blood cells (31.3% vs 19.8%, p=0.002) and fresh frozen plasma (9.8% vs 3.8%, p=0.008). Increased incidence was observed for platelet transfusion (4.8% vs 6.8%, p=0,530) and fibrinogen concentrate (0.9% vs 3.5%, p=0.066). Similar results were observed in the postoperative period, but with a decreased incidence of platelet transfusion (4.8% vs 3.8%, p=0.813). In addition, statistically significant reductions were detected in the incidence of postoperative bleeding (9.5% vs 5.3%, p=0.037) and surgical reexploration (6.0% vs 2.9%, p=0.035).Thus, the incidence of cardiac surgery complications in ICU decreased (55.8% vs 57.7%, p=0.275), especially acute postoperative pericarditis (3.6% vs 1.2%, p=0.043).Finally, we observed a lower rate of ICU readmissions for viscoelastic testing patients (4.6% VS 2.7%, p=0.201); and statistically significant reductions were detected in length of Intensive Care Unit (ICU) stay (6.0 days vs 5.3 days, p=0.026).In addition, we observed a decreased in total hospital stay (16.7 ±10.0 days vs 18.3±13.5 days, p=0.076), and in hospital mortality associated with cardiac surgery (4.5% vs 2.4%, p=0.132). CONCLUSIONS: The monitoring of hemostasis by ROTEM® in cardiac surgery, was associated with decreased incidence of allogeneic blood transfusion, clinical hematologic and cardiac postoperative complications and lengths of ICU stay. CLINICAL IMPLICATIONS: Finally, we have achieved great results, including decreased incidence of blood transfusion, decreased complications, lower lengths of stay in the ICU and a reduction cardiac surgery hospital cost (622,008 euros vs 312,750 euros). after ROTEM implementation. DISCLOSURES: No relevant relationships by Isabel Rodríguez Martín, source=Web Response

Preoperative Anemia Treatment with Intravenous Iron Therapy in Patients Undergoing Abdominal Surgery: A Systematic Review

IntroductionPreoperative anemia is associated with increased morbidity, mortality, and healthcare costs. As a result of the increased incidence of chronic blood loss and iron deficiency anemia in abdominal surgery patients and its impact on patient outcomes, we systematically evaluated the quality of evidence for preoperative intravenous (IV) administration of iron to patients with anemia undergoing major abdominal surgery with the focus on clinical outcomes.MethodsIn this systematic review, PubMed, Cochrane, The Cumulative Index to Nursing and Allied Health Literature, Web Of Science, and Excerpta Medica Database databases were searched up to 2019 using specific keywords. Inclusion criteria were patients that were over 18 years of age, underwent abdominal surgery, and received an IV iron treatment in the preoperative setting.ResultsThe nine studies included in the final systematic review do not provide consistent evidence of a reduced incidence of allogeneic blood transfusions with preoperative IV iron administration. However, IV iron administration did consistently cause a significant increase in hemoglobin levels relative to oral iron therapy or no iron.ConclusionOverall, these findings are consistent in that IV iron administration is highly effective at rapidly increasing hemoglobin levels in patients with iron deficiency anemia undergoing major abdominal surgery. Unfortunately, there is currently no evidence of reduced incidence of allogeneic blood transfusions or other enhanced outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-021-01628-7.

The incidence and risk factors for perioperative allogeneic blood transfusion in primary idiopathic scoliosis surgery.

Case-control study. Evaluate the rate and risk factors for perioperative allogeneic blood transfusion (ABT) in primary idiopathic scoliosis surgery at a single institution. Avoiding perioperative ABT is ideal as transfusions are associated with adverse reactions, increased rates of infection, prolonged hospitalization, additional laboratory testing, and increased cost. Risk factors identified in other studies have differed, and to our knowledge, few studies have identified clinical strategies to predict patients at high risk for ABT. We reviewed 402 idiopathic scoliosis patients who underwent primary posterior spinal fusion and instrumentation (PSFI) at a single institution from 2015 to 2017. Medical records and radiographs were reviewed for all patients. Transfused patients were compared to the remaining cohort to find significant differences and identify predictors of higher ABT risk. ABT occurred in 73 patients (18.2%), with the majority of transfusions occurring intraoperatively (41%) or postoperatively on the day of surgery (25%). The seven surgeons involved varied significantly in incidence of ABT (2.4-35.8%, p=0.002). Patients who had ABT were younger (13.3 vs. 14.1 years, p<0.01), had lower BMI (48th vs. 61st percentile, p<0.001), and lower preoperative hemoglobin (13.1 vs. 13.7 g/dL, p<0.01). Greater preoperative major Cobb angle (69° vs. 61.5°, p<0.001), number of fusion levels (11.8 vs. 10.3, p<0.001), and estimated blood loss (770 vs. 448 mL, p<0.001) also predicted ABT. ABT was associated with several risk factors, five of which are known preoperatively. Surgeons can use knowledge of these risk factors to assess transfusion risk preoperatively and plan surgery, blood management, and laboratory testing accordingly. The development of best practices for ordering ABT is possible given the variation amongst providers. Level III.

Impact of Preoperative Erythropoietin on Allogeneic Blood Transfusions in Surgical Patients: Results From a Systematic Review and Meta-analysis.

Erythropoietic-stimulating agents such as erythropoietin have been used as part of patient blood management programs to reduce or even avoid the use of allogeneic blood transfusions. We review the literature to evaluate the effect of preoperative erythropoietin use on the risk of exposure to perioperative allogeneic blood transfusions. The study involved a systematic review and meta-analysis of randomized controlled trials evaluating the use of preoperative erythropoietin. The primary outcome was the reported incidence of allogeneic red blood cell transfusions during inpatient hospitalizations. Secondary outcomes included phase-specific allogeneic red blood cell transfusions (ie, intraoperative, postoperative), intraoperative estimated blood loss, perioperative hemoglobin levels, length of stay, and thromboembolic events. A total of 32 randomized controlled trials (n = 4750 patients) were included, comparing preoperative erythropoietin (n = 2482 patients) to placebo (n = 2268 patients). Preoperative erythropoietin is associated with a significant decrease in incidence of allogeneic blood transfusions among all patients (n = 28 studies; risk ratio, 0.59; 95% CI, 0.47-0.73; P < .001) as well as patients undergoing cardiac (n = 9 studies; risk ratio, 0.55; 95% CI, 0.37-0.81; P = .003) and elective orthopedic (n = 5 studies; risk ratio, 0.36; 95% CI, 0.28-0.46; P < .001) surgery compared to placebo, respectively. Preoperative erythropoietin was also associated with fewer phase-specific red blood cell transfusions. There was no difference between groups in incidence of thromboembolic events (n = 28 studies; risk ratio, 1.02; 95% CI, 0.78-1.33; P = .68). Preoperative erythropoietin is associated with a significant reduction in perioperative allogeneic blood transfusions. This finding is also confirmed among the subset of patients undergoing cardiac and orthopedic surgery. Furthermore, our study demonstrates no significant increase in risk of thromboembolic complications with preoperative erythropoietin administration.

Increased 30-Day Complication Rates Associated with Laminectomy in 874 Adult Patients with Spinal Deformity Undergoing Elective Spinal Fusion: A Single Institutional Study.

Recent studies have reported that decompression with fusion leads to superior outcomes in correction of spinal deformity. The aim of this study was to determine if there is a difference in intraoperative and 30-day postoperative complication rates in patients undergoing spinal fusion with and without decompression. Medical records of 874 adult (≥18 years old) patients with spinal deformity undergoing elective spinal fusion at a major academic institution from 2005 to 2015 were reviewed; 374 (42.8%) patients underwent laminectomy in addition to spinal fusion. The primary outcome investigated was the rate of intraoperative and 30-day complications. Patient demographics and comorbidities were similar between groups. The laminectomy cohort had significantly higher estimated blood loss (P < 0.0001), incidence of allogeneic blood transfusions (P= 0.0001), and rate of intraoperative durotomies (laminectomy cohort 10.4% vs. no-laminectomy cohort 3.1%; P < 0.0001). The laminectomy cohort had a significantly higher proportion of patients in the intensive care unit (28.6% vs. 17.7%; P<0.001). There was no significant difference in 30-day readmission rate between cohorts (laminectomy cohort 13.0% vs. no-laminectomy cohort 9.8%; P= 0.13). Within 30days after initial discharge, the laminectomy cohort hadsignificantly higher rates of altered mental status (3.2%vs. 1.2%; P= 0.05), urinary tract infection (4.3% vs. 1.4%; P= 0.009), wound drainage (7.2% vs. 3.1%; P=0.007), and instrumentation failure (1.1% vs. 0.0%; P=0.03). Patients undergoing spinal fusion with laminectomy may have higher complication rates than patients undergoing spinal fusion alone.

Effect of preoperative autologous blood donation on patients undergoing bimaxillary orthognathic surgery: a retrospective analysis

The efficacy of preoperative autologous blood donation (PABD) was evaluated according to preoperative haemoglobin (Hb) values. The records of 295 patients who underwent bimaxillary orthognathic surgery between July 2007 and August 2008 were reviewed. The records for autologous blood donation, intraoperative transfusion, and related laboratory studies were also evaluated. The transfusion trigger used during this period was Hb <10g/dl. A total of 189 patients (64.1%) made a PABD and 106 patients (35.9%) did not. The incidence of allogeneic blood transfusion was significantly lower in the PABD group than in the no PABD group (15.9% vs. 29.2%, P=0.007). This difference was greater in patients with a preoperative Hb <14g/dl (20.3% vs. 62.5%, P<0.0001), and no difference was found in patients with Hb ≥14g/dl (13.3% vs. 14.9%, P=0.83). PABD reduced the incidence of allogeneic blood transfusion in patients undergoing bimaxillary orthognathic surgery, particularly in patients with a preoperative Hb <14g/dl. PABD could be used to reduce the frequency of intraoperative allogeneic blood transfusion in these patients.

Preoperative Blood Management Strategies for Total Knee Arthroplasty

Elective total knee arthroplasty is frequently associated with considerable blood loss and a concomitant decline in hemoglobin postoperatively. This often leads to high rates of allogeneic transfusions, with reports of up to 69%, to treat postoperative anemia. Allogeneic blood transfusions have been shown to be an independent risk factor for increased adverse outcomes, such as prolonged length of hospital stay and postoperative infections. Although multiple preoperative blood management strategies have been proposed, there are no concise guidelines, as few studies have compared the relative efficacy of these techniques. The aim of this review was to evaluate current evidence on the various preoperative blood management strategies for patients undergoing total knee arthroplasty and to provide an overview of the safety and efficacy of these practices. Specifically, we evaluated preoperative autologous blood donation, iron therapy, and intravenous erythropoietin. Current evidence suggests that these techniques independently may be effective at reducing the incidence of allogeneic blood transfusions, correcting preoperative, and preventing postoperative anemia. However, more studies are necessary to evaluate combination protocols, as well as the cost-effectiveness and safety of these practices as part of routine preoperative blood management for total knee arthroplasty.

First-line Therapy with Coagulation Factor Concentrates Combined with Point-of-Care Coagulation Testing Is Associated with Decreased Allogeneic Blood Transfusion in Cardiovascular Surgery

Blood transfusion is associated with increased morbidity and mortality. We developed and implemented an algorithm for coagulation management in cardiovascular surgery based on first-line administration of coagulation factor concentrates combined with point-of-care thromboelastometry/impedance aggregometry. In a retrospective cohort study including 3,865 patients, we analyzed the incidence of intraoperative allogeneic blood transfusions (primary endpoints) before and after algorithm implementation. Following algorithm implementation, the incidence of any allogeneic blood transfusion (52.5 vs. 42.2%; P < 0.0001), packed red blood cells (49.7 vs. 40.4%; P < 0.0001), and fresh frozen plasma (19.4 vs. 1.1%; P < 0.0001) decreased, whereas platelet transfusion increased (10.1 vs. 13.0%; P = 0.0041). Yearly transfusion of packed red blood cells (3,276 vs. 2,959 units; P < 0.0001) and fresh frozen plasma (1986 vs. 102 units; P < 0.0001) decreased, as did the median number of packed red blood cells and fresh frozen plasma per patient. The incidence of fibrinogen concentrate (3.73 vs. 10.01%; P < 0.0001) and prothrombin complex concentrate administration (4.42 vs. 8.9%; P < 0.0001) increased, as did their amount administered per year (179 vs. 702 g; P = 0.0008 and 162 × 10³ U vs. 388 × 10³ U; P = 0.0184, respectively). Despite a switch from aprotinin to tranexamic acid, an increase in use of dual antiplatelet therapy (2.7 vs. 13.7%; P < 0.0001), patients' age, proportion of females, emergency cases, and more complex surgery, the incidence of massive transfusion [(≥10 units packed red blood cells), (2.5 vs. 1.26%; P = 0.0057)] and unplanned reexploration (4.19 vs. 2.24%; P = 0.0007) decreased. Composite thrombotic/thromboembolic events (3.19 vs. 1.77%; P = 0.0115) decreased, but in-hospital mortality did not change (5.24 vs. 5.22%; P = 0.98). First-line administration of coagulation factor concentrates combined with point-of-care testing was associated with decreased incidence of blood transfusion and thrombotic/thromboembolic events.

Is Obesity a Contraindication for Minimal Invasive Total Knee Replacement? A Prospective Randomized Control Trial

Although total knee replacement (TKR) has been proven a very successful treatment modality for the end-stage knee osteoarthritis (OA) in obese patients, the rehabilitation period often is long and painful. Minimal invasive surgery (MIS) has gained much attention in TKR promising fast and less painful recovery. However, little is known about the effectiveness of the technique in the obese adult population. One hundred consecutive patients with body mass index (BMI) > 30 kg/m(2) and tricompartmental knee OA were randomly assigned to undergo either standard TKR (50 patients) or MIS-TKR (50 patients). The patients were assessed clinically and radiologically before the procedure and at subsequent postoperative follow-up visits, until 2 years after the operation. Knee society function and pain scores were significantly higher in MIS group for 3 months following surgery. Patients after MIS had also lower levels of pain during hospitalization. Tourniquet time was on average 7 min longer during MIS-TKR (p = 0.03) but operative time was almost equal in both groups (p = 0.11). No statistical significant difference was found between groups regarding the amount of blood loss (p = 0.49) or incidence of allogeneic blood transfusion (p = 0.27). Active straight leg raising was achieved 2.2 days earlier, on average, after MIS-TKR (p < 0.001). No severe complications or residual coronal and sagittal imbalance were identified. Component alignment was in normal limits and similar in both groups. In MIS group, higher BMI did not have a negative predictive effect on knee pain and function. MIS is a reliable and safe option in obese patients undergoing TKR regardless the level of BMI. It is associated with improved early clinical outcome without sacrificing radiographic positioning of the implants.

Autologous blood predonation in cardiac surgery

The risk of transfusion of allogeneic blood products on outcome is well documented. Autologous blood donation prior to elective cardiac surgery has repeatedly shown to be an effective practice to reduce the exposure to allogeneic blood, but was criticized because of the alleged high costs. We analyzed the data of 4878 patients undergoing elective open-heart surgery, in whom 18% underwent autologous donation. Overall, autologous blood donation reduced the incidence of allogeneic blood transfusion from 48 to 13% during hospitalization. Additionally, it is shown that diagnosis adjusted autologous blood donation is cost-effective. The higher the probability of transfusion the better is efficacy and cost-effectiveness of predonation. Cardiac surgery is a high-transfusion area, thus, it offers ideal conditions for autologous donation. Autologous blood donation still remains a promising and cost-effective alternative to reduce allogeneic blood transfusion in elective cardiac surgery.

Intraoperative Autotransfusion in Abdominal Aortic Aneurysm Surgery

To determine whether intraoperative autotransfusion reduces the percentage of patients undergoing allogeneic blood transfusion. Using a public domain database (MEDLINE) and a Web-based search engine (PubMed), all intraoperative autotransfusion vs control prospective randomized controlled trials that enrolled patients undergoing elective infrarenal abdominal aortic aneurysm surgery, published between January 1, 1966, and November 30, 2005, were searched. Relevant studies were identified through a manual search of secondary sources including references of initially identified articles. Data on detailed inclusion criteria, autotransfusion system type, and incidence of allogeneic blood transfusion were abstracted from each study. Sensitivity analyses were performed by excluding individual trials one at a time and recalculating the pooled risk ratio estimates for the remaining studies. Our search identified 4 randomized controlled trials including data for 292 patients. Pooled analysis demonstrated a statistically significant 37% reduction in risk of allogeneic blood transfusion with intraoperative autotransfusion compared with control (risk ratio, 0.63; 95% confidence interval, 0.41-0.95; P = .03) in a random-effects model. There was statistically significant trial heterogeneity of results (P = .02) but no evidence of statistically significant publication bias (P = .497). Two of 4 sensitivity analyses demonstrated statistically nonsignificant results favoring intraoperative autotransfusion. Based on a meta-analysis of available randomized controlled trials, intraoperative autotransfusion reduces risk of allogeneic blood transfusion in elective infrarenal abdominal aortic aneurysm surgery.

Platelet gel and fibrin sealant reduce allogeneic blood transfusions in total knee arthroplasty

Total knee arthroplasty (TKA) is often associated with a considerable amount of post-operative blood loss, necessitating the transfusion of allogeneic blood, which can add to the complications. Optimization of strategies to reduce the need for blood transfusion is desired. This study was designed to evaluate the efficacy of autologous platelet gel and fibrin sealant in unilateral TKA. Consecutive patients were operated on and assigned to the study and control groups. Study group patients (n = 85) were operated on according to our standard TKA protocol, with the application of autologous platelet gel and fibrin sealant on the wound tissues at the end of surgery. Eighty patients were operated on according to the same protocol, but without the use of platelet gel and fibrin sealant, and served as the control group. All blood transfusions, occurrence of wound leakage, wound healing disturbances and incidences of post-operative infections were recorded. Patients in the treatment group had a significantly higher post-operative haemoglobin level (11.3 vs. 8.9 g/dl, respectively) and a decreased need for allogeneic blood products (0.17 vs. 0.52 units, respectively) than those in the control group (P < 0.001). The incidences of wound leakage and wound healing disturbance were significantly less (P < 0.001) in patients managed with platelet gel and fibrin sealant. Four patients in the control group, who received blood products, developed wound infection. The hospital stay was decreased by 1.4 +/- 1.5 days for patients in the treatment group (P < 0.001). Peri-operatively applied platelet gel and fibrin sealant may reduce the incidence of allogeneic blood transfusions and complications associated with TKA.

Blood Salvage in Total Hip and Knee Arthroplasty in a Community Hospital: A Retrospective Study

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. 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. 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. 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.

Blood management for patients with hemoglobin level lower than 130 g/l in total knee arthroplasty.

The risk of requiring allogeneic blood transfusion after total knee arthroplasty has been recently decreased with several methods such as blood donation, blood salvage, and hematinic. For patients with a low baseline hemoglobin level, however, the rate of allogeneic transfusion is still high, and an effective method for avoiding allogeneic blood transfusion has not been established. We introduced intra- and postoperative blood salvage with the Cell Saver for patients with a baseline hemoglobin level lower than 130 g/l and analyzed the frequency of allogeneic blood transfusion. From 1993 to 1997, 218 consecutive total knee arthroplasties were performed, and 155 knees with baseline hemoglobin lower than 130 g/l were included in this study. Baseline hemoglobin ranged from 62 to 129 g/l, with a mean of 110 g/l. All patients were managed with intra- and postoperative blood salvage with the Cell Saver. Preoperative autologous blood donation and/or use of hematinic was performed for 129 knees (group 1) and was not performed for 26 knees (group 2). There were no significant differences between the two groups with regard to preoperative factors. To examine the role of perioperative factors (age, sex, baseline hemoglobin level, revision procedure, preoperative blood donation, and use of hematinic) in determining the requirements for allogeneic transfusion, backward elimination logistic regression analysis was used. Seven knees (4.5%) required allogeneic transfusion. Group 1 (2.3%) exhibited a lower rate of allogeneic blood transfusion than group 2 (15.4%) (p=0.016). Hemoglobin levels on the day (p=0.016), 1 week (p=0.0001), and 2 weeks (p=0.007) after surgery were lower in group 1 than in group 2. Backward elimination logistic regression analysis showed that preoperative blood donation (p=0.048) and use of hematinic (p=0.040) were significantly associated with a requirement for allogeneic blood transfusion. Preoperative blood donation and use of hematinic were associated with a low incidence of allogeneic blood transfusion after total knee arthloplasty with intra- and postoperative blood salvage, even for patients with a baseline hemoglobin level below 130 g/l.

Effect of combined preoperative donation and normovolemic hemodilutional autologous blood transfusions in extensive operations for gynecologic tumors

The aim of this study was to retrospectively evaluate the effect of the combination of preoperative donation and acute normovolemic hemodilution of the autologous blood in gynecologic operations. The records of 42 patients undergoing extensive gynecologic operations with a blood loss of 800 ml and who received either no autologous transfusion (n = 7), hemodilution alone (n = 19) or the combination of preoperative donation and hemodilution (n = 16) were reviewed. The incidence and volume of allogeneic blood transfusion and postoperative anemia were analyzed. The incidence of allogeneic blood transfusions was 85.7%, 26.3% (P = 0.02), and 20% (P < 0.01), respectively for no autologous, hemodilution alone, and combined groups. The ratio of transfused volume to blood loss was 60.6%, 42.0% (P = 0.03), and 32.0% (P = 0.04), respectively. Postoperative hemoglobins were significantly higher (P < 0.01) in the combined group than the hemodilution group on days one, seven and 14. The combination of preoperative donation and acute normovolemic hemodilution of the autologous blood is effective and further prospective studies may confirm reduced need and risk of allogeneic transfusion.