Efficacy of the methods to reduce the allogenic transfusion in primary knee arthroplasty

Ana-Maria Munteanu
Clinica ATI, Spitalul Clinic de Ortopedie „Foişor”, Bucureşti

Abstract

Goal: Prospective controlled study that compares the efficacy of preoperative autologous blood donation (PABD), normovolemic hemodilution (NVH) and postoperative reinfusion of shed blood using a Constavac Stryker device, performed alone and in combination, to avoid allogenic transfusion in primary knee arthroplasty.

Method: 250 patients (ASA I-II, Hct > 35%, age > 18 years, W > 40 kg, H > 155 cm) scheduled for knee arthroplasty, randomized in 5 equal groups: group 1 – controls; group 2 – PABD; group 3 – CVAC; group 4 – PABD + NHV; group 5 – PABD + CVAC.
The perioperative Hct transfusion trigger was 24% for healthy patients, 27% for those with stable coronary or respiratory diseases and 30% in case of angina, ST abnormalities, hemodynamic instability, hypoxia. Recorded data: Hb/Hct before and after PABD/NVH/surgery, volume of bleeding, volume and Hct of reinfused shed blood, volume of allogenic blood transfused, complications.

Results: There were no significant differences among groups concerning demographic data and initial and final Hct level. The mean volume of blood reinfused with the Constavac device was 1137 + 470 ml with Hct 22%, which is the equivalent of 500 + 200 ml whole blood with Hct 40%, or 1.2 + 0.5 U representing 25 + 10% of the total blood loss. The total blood loss averaged 2500 ml, 1.4-1.9 greater than the observed loss and requires transfusion in 60% of the patients. The use of PABD or CVAC alone did not reduce the risk of allogenic transfusion, as well as the combination PABD + NVH, which lowered the risk by 20% (p = 0.1). The combination PABD + CVAC significantly reduced the absolute risk (from 60% in controls to 24% in PABD + CVAC group, absolute risk reduction by 36%) (p < 0.001) and could avoid allogenic blood in 1 of 3 patients (NNT = 3).
Conclusions: In patients with knee arthroplasty, the combination PABD + CVAC could avoid allogenic transfusion in 1 of 3 patients (NNT = 3).

Keywords: allogenic transfusion, autologous transfusion, PABD, NVH, Constavac, knee arthroplasty, perioperative anemia

J Rom Anest Terap Int 2009; 16: 107-113

Analgezia peridurală controlată de către pacientă comparativ cu infuzia peridurală continuă la naştere folosind levobupivacaina