title: Preoperative platelet-rich plasmapheresis and hemodilution with an autotransfusion device in total hip replacement surgery.
abstract: The effectiveness of both preoperative autologous donation (PAD) and intraoperative autotransfusion (IAT) with an autotransfusion device has recently been questioned. Preoperative apheresis, with separation of concentrated platelet rich-plasma (c-PRP) and erythrocyte concentrate (ERC), represents an aggressive use of the autotransfusion device. Can such a procedure replace PAD in total hip replacement surgery (THR)? Eighty patients undergoing THR were investigated in a prospective and randomized study. Forty patients underwent PAD, and 2 units of ERC + plasma were retrieved within 4 weeks preoperatively. Another 40 patients underwent an immediately preoperative apheresis with a concomitant hemodilution with 4% albumin, retrieving c-PRP (30% of the platelet pool) and 2 units of ERC. Both groups used IAT up to 2 hours postoperatively, with 3% dextran-60 as a plasma substitute according to our standard of care. There were no differences in blood loss, B-hemoglobin or allogeneic transfusions between the groups: 85% of the patients did not receive allogeneic blood. Both apheresis and reinfusion of c-PRP had minor impact on the coagulation parameters. Platelet count increased slightly but significantly (P<0.05) from 154 to 179 x 10(9)/L after the c-PRP at wound closure. Preoperative apheresis with an autotransfusion device, separating platelet-rich plasma and erythrocyte concentrate, is a useful alternative for patients who are unable to utilize the PAD technique for either religious or practical reasons.
authors: Department of Anesthesiology and Intensive Care, Orebro Medical Center Hospital, Orebro, Sweden.
authors: G
authors: G
authors: Ekbäck
authors: L
authors: L
authors: Ryttberg
authors: K
authors: K
authors: Axelsson
authors: F
authors: F
authors: Christianssen
authors: J
authors: J
authors: Kjellberg
authors: P
authors: P
authors: Carlsson
authors: O
authors: O
authors: Carlsson
authors: U
authors: U
authors: Schött
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D001804:Blood Transfusion, Autologous / Q000295:instrumentation*; D005260:Female; D006438:Hemodilution; D006801:Humans; D008297:Male; D008875:Middle Aged; D010983:Plateletpheresis