Download PDF
J Knee Surg 2013; 26(06): 373-378
DOI: 10.1055/s-0033-1357492
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Preoperative Blood Management Strategies for Total Knee Arthroplasty

Bhaveen H. Kapadia
1   Rubin Institute for Advanced Orthopaedics; Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Samik Banerjee
1   Rubin Institute for Advanced Orthopaedics; Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Kimona Issa
1   Rubin Institute for Advanced Orthopaedics; Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Mark J. McElroy
1   Rubin Institute for Advanced Orthopaedics; Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Steven F. Harwin
2   Division of Adult Reconstruction, Department of Orthopaedic Surgery, Beth Israel Medical Center, New York, New York
,
Michael A. Mont
1   Rubin Institute for Advanced Orthopaedics; Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

17 July 2013

25 August 2013

Publication Date:
11 October 2013 (online)

    Permissions and Reprints

Abstract

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.

Keywords

preoperative blood management - erythropoietin - preoperative autologous blood donation - preoperative iron therapy
 

  • References

  • 1 Gonzalez-Porras JR, Colado E, Conde MP, Lopez T, Nieto MJ, Corral M. An individualized pre-operative blood saving protocol can increase pre-operative haemoglobin levels and reduce the need for transfusion in elective total hip or knee arthroplasty. Transfus Med 2009; 19 (1) 35-42
    CrossrefPubMedGoogle Scholar
  • 2 Wells AW, Mounter PJ, Chapman CE, Stainsby D, Wallis JP. Where does blood go? Prospective observational study of red cell transfusion in north England. BMJ 2002; 325 (7368) 803
    CrossrefPubMedGoogle Scholar
  • 3 Voorn VM, Marang-van de Mheen PJ, So-Osman C , et al; LISBOA Study Group. Designing a strategy to implement cost-effective blood transfusion management in elective hip and knee arthroplasties: a study protocol. Implement Sci 2012; 7: 58
    CrossrefPubMedGoogle Scholar
  • 4 Spahn DR. Anemia and patient blood management in hip and knee surgery: a systematic review of the literature. Anesthesiology 2010; 113 (2) 482-495
    Google Scholar
  • 5 Spahn DR, Moch H, Hofmann A, Isbister JP. Patient blood management: the pragmatic solution for the problems with blood transfusions. Anesthesiology 2008; 109 (6) 951-953
    CrossrefPubMedGoogle Scholar
  • 6 Billote DB, Glisson SN, Green D, Wixson RL. Efficacy of preoperative autologous blood donation: analysis of blood loss and transfusion practice in total hip replacement. J Clin Anesth 2000; 12 (7) 537-542
    CrossrefPubMedGoogle Scholar
  • 7 Savoia HF, Metz J, Maxwell EL, Hauesler MN, Mellor J, Kiely S. Utilization of preoperative autologous blood donation in elective surgery. ANZ J Surg 2002; 72 (8) 557-560
    CrossrefPubMedGoogle Scholar
  • 8 Franchini M, Regis D, Gandini G, Corallo F, de Gironcoli M, Aprili G. Preoperative autologous blood donation in primary total knee arthroplasty: a single-centre experience on 214 consecutive patients. Vox Sang 2006; 90 (3) 191-194
    CrossrefPubMedGoogle Scholar
  • 9 Zou S, Dorsey KA, Notari EP , et al. Prevalence, incidence, and residual risk of human immunodeficiency virus and hepatitis C virus infections among United States blood donors since the introduction of nucleic acid testing. Transfusion 2010; 50 (7) 1495-1504
    CrossrefPubMedGoogle Scholar
  • 10 Sculco TP, Gallina J. Blood management experience: relationship between autologous blood donation and transfusion in orthopedic surgery. Orthopedics 1999; 22 (1) (Suppl): s129-s134
    PubMedGoogle Scholar
  • 11 Goldman EB. Legal considerations for allogeneic blood transfusion. Am J Surg 1995; 170 (6A) (Suppl): 27S-31S
    CrossrefPubMedGoogle Scholar
  • 12 Kanter MH, van Maanen D, Anders KH, Castro F, Mya WW, Clark K. Preoperative autologous blood donations before elective hysterectomy. JAMA 1996; 276 (10) 798-801
    CrossrefPubMedGoogle Scholar
  • 13 Mezrow CK, Bergstein I, Tartter PI. Postoperative infections following autologous and homologous blood transfusions. Transfusion 1992; 32 (1) 27-30
    CrossrefPubMedGoogle Scholar
  • 14 AuBuchon JP. Cost-effectiveness of preoperative autologous blood donation for orthopedic and cardiac surgeries. Am J Med 1996; 101 (2A) 38S-42S
    CrossrefPubMedGoogle Scholar
  • 15 Etchason J, Petz L, Keeler E , et al. The cost effectiveness of preoperative autologous blood donations. N Engl J Med 1995; 332 (11) 719-724
    CrossrefPubMedGoogle Scholar
  • 16 Forgie MA, Wells PS, Laupacis A, Fergusson D. International Study of Perioperative Transfusion (ISPOT) Investigators. Preoperative autologous donation decreases allogeneic transfusion but increases exposure to all red blood cell transfusion: results of a meta-analysis. Arch Intern Med 1998; 158 (6) 610-616
    CrossrefPubMedGoogle Scholar
  • 17 Feagan BG, Wong CJ, Lau CY, Wheeler SL, Sue-A-Quan G, Kirkley A. Transfusion practice in elective orthopaedic surgery. Transfus Med 2001; 11 (2) 87-95
    CrossrefPubMedGoogle Scholar
  • 18 Gandini G, Franchini M, de Gironcoli M , et al. Preoperative autologous blood donation by elderly patients undergoing orthopaedic surgery. Vox Sang 2001; 80 (2) 95-100
    CrossrefPubMedGoogle Scholar
  • 19 Henry DA, Carless PA, Moxey AJ , et al. Pre-operative autologous donation for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2002; (2) CD003602
    PubMedGoogle Scholar
  • 20 Schved JF. Preoperative autologous blood donation: a therapy that needs to be scientifically evaluated. Transfus Clin Biol 2005; 12 (5) 365-369
    CrossrefPubMedGoogle Scholar
  • 21 Singbartl G, Schreiber J, Singbartl K. Preoperative autologous blood donation versus intraoperative blood salvage: intraindividual analyses and modeling of efficacy in 1103 patients. Transfusion 2009; 49 (11) 2374-2383
    CrossrefPubMedGoogle Scholar
  • 22 Muñoz M, García-Erce JA. Preoperative autologous blood donation in lower limb arthroplasty surgery: has the time come for its retirement?. Blood Transfus 2013; 11 (3) 333-336
    PubMedGoogle Scholar
  • 23 Piednoir P, Allou N, Driss F , et al. Preoperative iron deficiency increases transfusion requirements and fatigue in cardiac surgery patients: a prospective observational study. Eur J Anaesthesiol 2011; 28 (11) 796-801
    CrossrefPubMedGoogle Scholar
  • 24 Basora M, Deulofeu R, Salazar F, Quinto L, Gomar C. Improved preoperative iron status assessment by soluble transferrin receptor in elderly patients undergoing knee and hip replacement. Clin Lab Haematol 2006; 28 (6) 370-375
    CrossrefPubMedGoogle Scholar
  • 25 Theusinger OM, Leyvraz PF, Schanz U, Seifert B, Spahn DR. Treatment of iron deficiency anemia in orthopedic surgery with intravenous iron: efficacy and limits: a prospective study. Anesthesiology 2007; 107 (6) 923-927
    CrossrefPubMedGoogle Scholar
  • 26 Yang Y, Li H, Li B, Wang Y, Jiang S, Jiang L. Efficacy and safety of iron supplementation for the elderly patients undergoing hip or knee surgery: a meta-analysis of randomized controlled trials. J Surg Res 2011; 171 (2) e201-e207
    CrossrefPubMedGoogle Scholar
  • 27 Muñoz M, García-Erce JA, Díez-Lobo AI, Campos A, Sebastianes C, Bisbe E. Anaemia Working Group España (AWGE). [Usefulness of the administration of intravenous iron sucrose for the correction of preoperative anemia in major surgery patients]. Med Clin (Barc) 2009; 132 (8) 303-306
    CrossrefPubMedGoogle Scholar
  • 28 Edwards TJ, Noble EJ, Durran A, Mellor N, Hosie KB. Randomized clinical trial of preoperative intravenous iron sucrose to reduce blood transfusion in anaemic patients after colorectal cancer surgery. Br J Surg 2009; 96 (10) 1122-1128
    CrossrefPubMedGoogle Scholar
  • 29 Fotland SS, Reikvam H, Hervig T, Seghatchian J. Does the preoperative iron status predict transfusion requirement of orthopedic patients?. Transfus Apheresis Sci 2009; 40 (3) 213-217
    CrossrefPubMedGoogle Scholar
  • 30 Lachance K, Savoie M, Bernard M , et al. Oral ferrous sulfate does not increase preoperative hemoglobin in patients scheduled for hip or knee arthroplasty. Ann Pharmacother 2011; 45 (6) 764-770
    CrossrefPubMedGoogle Scholar
  • 31 Blanco Rubio N, Llorens Eizaguerri M, Seral García B, Burillo Fuertes P, Ranera García M, Albareda Albareda J. Preoperative intravenous iron as a strategy for blood conservation in surgery for hip fracture [in Spanish]. Med Clin (Barc) 2012; (Epub ahead of print)
    PubMedGoogle Scholar
  • 32 Bieber E. Erythropoietin, the biology of erythropoiesis and epoetin alfa. An overview. J Reprod Med 2001; 46 (5) (Suppl): 521-530
    PubMedGoogle Scholar
  • 33 Keating EM. Preoperative evaluation and methods to reduce blood use in orthopedic surgery. Anesthesiol Clin North America 2005; 23 (2) 305-313 , vi–vii.
    CrossrefPubMedGoogle Scholar
  • 34 Deutsch A, Spaulding J, Marcus RE. Preoperative epoetin alfa vs autologous blood donation in primary total knee arthroplasty. J Arthroplasty 2006; 21 (5) 628-635
    CrossrefPubMedGoogle Scholar
  • 35 Cushner FD, Locker JR, Hanssen AD , et al. Use of recombinant human erythropoietin in two-stage total knee arthroplasty for infection. Clin Orthop Relat Res 2001; (392) 116-123
    PubMedGoogle Scholar
  • 36 Laffosse JM, Minville V, Chiron P , et al. Preoperative use of epoetin beta in total hip replacement: a prospective study. Arch Orthop Trauma Surg 2010; 130 (1) 41-45
    CrossrefPubMedGoogle Scholar
  • 37 Martinez V, Monsaingeon-Lion A, Cherif K, Judet T, Chauvin M, Fletcher D. Transfusion strategy for primary knee and hip arthroplasty: impact of an algorithm to lower transfusion rates and hospital costs. Br J Anaesth 2007; 99 (6) 794-800
    CrossrefPubMedGoogle Scholar
  • 38 Moonen AF, Thomassen BJ, Knoors NT, van Os JJ, Verburg AD, Pilot P. 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. J Bone Joint Surg Br 2008; 90 (8) 1079-1083
    PubMedGoogle Scholar
  • 39 Billote DB, Glisson SN, Green D, Wixson RL. A prospective, randomized study of preoperative autologous donation for hip replacement surgery. J Bone Joint Surg Am 2002; 84-A (8) 1299-1304
    PubMedGoogle Scholar
  • 40 Pierson JL, Hannon TJ, Earles DR. A blood-conservation algorithm to reduce blood transfusions after total hip and knee arthroplasty. J Bone Joint Surg Am 2004; 86-A (7) 1512-1518
    PubMedGoogle Scholar
  • 41 de Andrade JR, Jove M, Landon G, Frei D, Guilfoyle M, Young DC. Baseline hemoglobin as a predictor of risk of transfusion and response to Epoetin alfa in orthopedic surgery patients. Am J Orthop 1996; 25 (8) 533-542
    PubMedGoogle Scholar
  • 42 Faris PM, Ritter MA, Abels RI. The American Erythropoietin Study Group. The effects of recombinant human erythropoietin on perioperative transfusion requirements in patients having a major orthopaedic operation. J Bone Joint Surg Am 1996; 78 (1) 62-72
    PubMedGoogle Scholar
  • 43 Cushner FD, Lee GC, Scuderi GR, Arsht SJ, Scott WN. Blood loss management in high-risk patients undergoing total knee arthroplasty: a comparison of two techniques. J Knee Surg 2006; 19 (4) 249-253
    Article in Thieme ConnectPubMedGoogle Scholar
  • 44 Lee GC, Hawes T, Cushner FD, Scott WN. Current trends in blood conservation in total knee arthroplasty. Clin Orthop Relat Res 2005; (440) 170-174
    PubMedGoogle Scholar