Hemodynamic Analysis of Patients Who Underwent Arthroplasty without Blood Transfusion

You-Sung Suh; Hyung-Suk Choi; Sung-Hun Won; Myoung-Hoe Kim; Dong-Il Chun; Jae-Hwi Nho

doi:10.4055/jkoa.2010.45.6.456

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Suh, Choi, Won, Kim, Chun, and Nho: Hemodynamic Analysis of Patients Who Underwent Arthroplasty without Blood Transfusion

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2010; 45(6): 456-463.

Published online: 24 December 2010

DOI: https://doi.org/10.4055/jkoa.2010.45.6.456

Hemodynamic Analysis of Patients Who Underwent Arthroplasty without Blood Transfusion

You-Sung Suh, M.D., Hyung-Suk Choi, M.D., Sung-Hun Won, M.D., Myoung-Hoe Kim, M.D., Dong-Il Chun, M.D., Jae-Hwi Nho, M.D.

Department of Orthopedic Surgery, Soonchunhyang University College of Medicine, Seoul, Korea.

Correspondence to: Hyung-Suk Choi, M.D. Department of Orthopedic Surgery, Soonchunhyang University Hospital, 22, Daesagwan-gil (657 Hannam-dong), Yongsan-gu, Seoul 140-743, Korea. TEL: +82-2-709-9250, FAX: +82-2-794-9414 knee@schmc.ac.kr

Received 25 May 2010 Accepted 9 August 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze the hemodynamic changes in patients who underwent total joint arthroplasty and received alternative treatment to blood transfusion.

Materials and Methods

Fifty-seven cases in 48 patients who received total knee and hip arthroplasty between 1998 September and 2008 February were enrolled. The mean age at the point of surgery was 70.9 years. The types of joint arthroplasty included 15 cases of total knee arthroplsty and 42 cases of total hip arthroplasy. Alternatives to blood transfusion entailed administration of 2,000 units of recombinant EPO and oral iron supplement for 1 week in patients with preoperative hemoglobin level higher than 10 g/dl, and 4,000 units of recombinant EPO with oral iron supplement or venoferrum for 1 week in patients with preoperative hemoglobin level lower than 10 g/dl. Intra-operatively, autotransfusion, plasma expander, topical hemostatic agents were used irrespective of the preoperative hemoglobin level. Postoperatively, 4,000 unit of recombinant EPO and venoferrum were administered for one week.

Results

Patients with mean hemoglobin level higher than 10 g/dl exhibited mean hemoglobin level of 10.7 g/dl (a mean 1.85 g/dl decrease) 7 days after the operation. Patients with mean hemoglobin level lower than 10 g/dl exhibited increased mean hemoglobin level of 9.18 g/dl (a mean 0.38 g/dl decrease) 7 days after the operation. Patients who underwent total knee arthroplasty exhibited reduction of hemoglobin from 12.8 g/dl to 10.96 g/dl (a mean decrease of 1.4 g/dl) 7 days after the operation. Patients who underwent total hip arthroplasty exhibited a change of hemoglobin from 13.4 g/dl to 11.8 g/dl (a mean decrease of 1.84 g/dl) 7 days after the operation. Patients who underwent revision arhtroplasty exhibited a change of hemoglobin from 13.8 g/dl to 12.75 g/dl (a mean decrease of 1.05 g/dl) 7days after the operation.

Conclusion

In patients who refuse blood transfusion, there is a need to establish an adequate alternative blood management plan for surgery, such as total joint arthroplasty. We obtained good results with the hemodynamic protocol adapted for the perioperative period.

Keywords: arthroplasty, transfusion, alternative blood management

Figures and Tables

Figure 1

Changes of hemoglobin level from baseline to postoperative day 7.

Table 1

Demograpphic Characteristics and Baseline Variables

Table 2

Characteristics of Underlying Diseases of Arthroplasty Procedures

Table 3

Type of Surgery in the Current Study

Table 4

Summary for Alternative Blood Management Protocol

Table 5

Hemodynamic Changes according to the Time Period from Baseline to Postoperative 7 Days

References

1. Janssens M, Joris J, David JL, Lemaire R, Lamy M. High-dose aprotinin reduces blood loss in patients undergoing total hip replacement surgery. Anesthesiology. 1994. 80:23–29.

2. Toy PT, Kaplan EB, McVay PA, Lee SJ, Strauss RG, Stehling LC. Blood loss and replacement in total hip arthroplasty: a multicenter study. The Preoperative Autologous Blood Donation Study Group. Transfusion. 1992. 32:63–67.

3. 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. 90:1079–1083.

4. Stehling L. Autotransfusion and hemodilution in anesthesia. Anesthesia. 1990. 3rd ed. New York: Churchill Livingstone;1508–1510.

5. Byrne MP. Abdominal aortic aneurysm surgery in the Jehovah's Witness. Use of auto transfusion. IMJ Ill Med J. 1976. 150:87–90.

6. Ottesen S, Frøysaker T. Use of haemonetics cell saver for autotransfusion in cardiovascular surgery. Scand J Thorac Cardiovasc Surg. 1982. 16:263–268.

7. Lichtiger B, Dupuis JF, Seski J. Hemotherapy during surgery for Jehovah's witnesses: a new method. Anesth Analg. 1982. 61:618–619.

8. Winearls CG, Oliver DO, Pippard MJ, Reid C, Downing MR, Cotes PM. Effect of human erythropoietin derived from recombinant DNA on the anaemia of patients maintained by chronic haemodialysis. Lancet. 1986. 2:1175–1178.

9. Eschbach JW, Egrie JC, Downing MR, Browne JK, Adamson JW. Correction of the anemia of end-stage renal disease with recombinant human erythropoietin. N Engl J Med. 1987. 316:73–78.

10. 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 (Belle Mead NJ). 1996. 25:533–542.

11. Weber EW, Slappendel R, Hémon Y, et al. Effects of epoetin alfa on blood transfusions and postoperative recovery in orthopaedic surgery: the European Epoetin Alfa Surgery Trial (EEST). Eur J Anaesthesiol. 2005. 22:249–257.

12. Dixon JL, Smalley MG. Jehovah's Witnesses. The surgical/ethical challenge. JAMA. 1981. 246:2471–2472.

13. Nelson CL, Bowen WS. Total hip arthroplasty in Jehovah's Witnesses without blood transfusion. J Bone Joint Surg Am. 1986. 68:350–353.

14. Lotke PA, Faralli VJ, Orenstein EM, Ecker ML. Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion. J Bone Joint Surg Am. 1991. 73:1037–1040.

15. Konishi A, Kikuchi K. Advertisement of bloodless medicine: the role of the department of anesthesiology. Autotransfusion. 1996. 9:17–19.

16. Faris PM, Ritter MA. Epoetin alfa. A bloodless approach for the treatment of perioperative anemia. Clin Orthop Relat Res. 1998. 357:60–67.

17. Nelson CL, Fontenot HJ, Flahiff C, Stewart J. An algorithm to optimize perioperative blood management in surgery. Clin Orthop Relat Res. 1998. 357:36–42.

18. Moonen AF, Neal TD, Pilot P. Peri-operative blood management in elective orthopaedic surgery. A critical review of the literature. Injury. 2006. 37:Suppl 5. S11–S16.

19. Deutsch A, Spaulding J, Marcus RE. Preoperative epoetin alfa vs autologous blood donation in primary total knee arthroplasty. J Arthroplasty. 2006. 21:628–635.

20. Nelson CL, Stewart JG. Primary and revision total hip replacement in patients who are Jehovah's Witnesses. Clin Orthop Relat Res. 1999. 369:251–261.

21. Thomas GI, Edmark KW, Jones TW. Some issues involved with major surgery on Jehovah's witnesses. Am Surg. 1968. 34:538–544.

22. Rosenberg AG. Reducing blood loss in total joint surgery with a saline-coupled bipolar sealing technology. J Arthroplasty. 2007. 22:4 Suppl 1. 82–85.

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