title: Blood saving protocol in elective total knee arthroplasty.
abstract: BACKGROUND
  To eliminate the need for allogeneic blood transfusion in patients undergoing elective total knee arthroplasty, we established and tried a protocol of combined methods, which is characterized by effectiveness, ease in application, and safety. It is based on perioperative administration of human recombinant erythropoietin plus iron and folic acid, mild acute normovolemic hemodilution, meticulous surgical technique, postoperative blood salvage through a closed-wound drainage system, and lower transfusion triggers.
  
  
  METHODS
  Sixty-one patients entered the protocol, and the results were retrospectively compared with the ones obtained from 58 consecutive patients who were operated on in the past before the use of any blood saving technique.
  
  
  CONCLUSIONS
  Only 5 patients of those who entered the protocol finally needed allogeneic blood transfusion, receiving a total number of 7 units, which is remarkable when compared with the 50 patients before the application of the protocol who required 111 units. Consequently, the utilization of allogeneic blood was reduced by 94%, a statistically quite significant result (P <0,001). We believe the protocol should be included in orthopedic surgeons' alternatives for blood saving in elective total knee arthroplasty.
authors.affiliation: Department of Orthopedics, General Prefectural Hospital of Aegion, Ano Voulomeno, 25 100 Aegion, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kourtzis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Pafilas
authors.forename: Georgios
authors.initials: G
authors.lastname: Kasimatis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001803:Blood Transfusion; D001804:Blood Transfusion, Autologous / Q000379:methods; D002985:Clinical Protocols; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D005296:Ferrous Compounds / Q000627:therapeutic use; D005492:Folic Acid / Q000627:therapeutic use; D006397:Hematinics / Q000627:therapeutic use*; D006488:Hemostasis, Surgical / Q000379:methods; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D012189:Retrospective Studies
chemical_list: D005296:Ferrous Compounds; D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; C020748:ferrous sulfate; D005492:Folic Acid