Autologous blood transfusion in hip replacement. No effect on blood loss but less increase of plasminogen activator inhibitor in a randomized series of 80 patients.
80 patients underwent total hip replacement (THR) for primary coxarthrosis. In a randomized study, half of them donated 2 units of blood before operation. One unit was collected 4 weeks and one 2 weeks before the scheduled THR. All except 1 patient tolerated the predonations well. Total blood losses were similar in both groups. Additional bank blood was given in 7/38 in the predonation group, compared to 29/40 in the control group. Hemostatic parameters were studied in 10 consecutive patients in each group. Plasminogen activator inhibitor 1 (PAI-1), a possible risk parameter for thromboembolism, was significantly more increased postoperatively in the control group, which received only homologous blood. Platelet count, prothrombin complex, antithrombin III and von Willebrand factor antigen were significantly reduced and C reactive protein increased after surgery in both groups. We recommend predonation of 2 autologous units before a primary THR. In most cases, such predonation makes homologous blood transfusion unnecessary. The use of predonated blood causes no reduction of blood loss in THRs, but the increase in PAI-1 seen after homologous transfusions is avoided.
Hedström
M
M
Karolinska Institute Department of Orthopedics, Danderyd Hospital, Sweden.
Flordal
P A
PA
Ahl
T
T
Svensson
J
J
Dalén
N
N
D000368:Aged; D000990:Antithrombin III / Q000032:analysis; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D001804:Blood Transfusion, Autologous; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis; D010976:Platelet Count; D011300:Preoperative Care; D011516:Prothrombin / Q000032:analysis; D013997:Time Factors; D014841:von Willebrand Factor / Q000032:analysis
D017395:Plasminogen Activator Inhibitor 1; D014841:von Willebrand Factor; D000990:Antithrombin III; D011516:Prothrombin; D002097:C-Reactive Protein