Postoperative washed red cell reinfusion reduces allogeneic transfusion requirements after total knee replacement

Editorial: TATM
Fecha: 01/12/2006

In patients undergoing total knee replacement (TKR), most of blood loss occurs during the postoperative period and 30–50% of these patients receive allogeneic blood transfusion (ABT). For this reason, salvage and return of washed shed blood (WSB) from postoperative drainage may represent an alternative to ABT in these patients. We have, therefore, evaluated the clinical utility of WSB return in TKR patients. Data from 220 consecutive TKR patients were prospectively collected. WSB salvage and reinfusion (OrthoPAT, Haemonetics Corp., Braintree, MA, USA) were intended for 115 patients (reinfusion group), whereas the remaining 105 patients served as a control group. Patients received ABT if their hemoglobin concentration was lower than 8.0 g/dL or they showed clinical signs and symptoms of acute anemia. WSB return was possible in 97 patients who received a mean of 283 ± 180 mL of red cells (hematocrit, 66% ± 4%), without any clinically relevant incident. Return of WSB decreased both the ABT rate (50% vs. 19%, for control and reinfusion groups, respectively; P < 0.01) and the ABT index (0.86 ± 0.99 vs. 0.35 ± 0.83 units/patient, respectively; P < 0.01). In addition, when compared with those in the control group, patients in the reinfusion group had less postoperative infections (11.4% vs. 4.3%; P < 0.05), recovered the ability to walk 1 day earlier (P < 0.01), and had shorter hospital stay (P < 0.01). Return of WSB after TKR seems to effectively reduce postoperative requirements for ABT. However, for patients with preoperative hemoglobin concentrations below 13.0 g/dL, additional blood-saving methods should be combined with WSB return

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