title: Orthopaedic-induced anemia: the fallacy of autologous donation programs.
abstract: Total knee arthroplasty is associated with significant blood loss. Despite the initiation of various blood conservation modalities, allogeneic transfusion has yet to be eliminated. One hundred forty-eight patients who had unilateral primary total knee arthroplasties during a 3-year period were evaluated retrospectively for blood loss and transfusion rates. The patients were prescribed one unit of preoperative autologous donation that was to be transfused automatically on postoperative Day 1. Allogeneic transfusion was based on symptoms, and no numerical transfusion triggers were used. The preoperative autologous donation program resulted in increased preoperative anemia. Whereas only 26.2% of patients were in the high transfusion-risk group (hemoglobin >10 g/dL and < or = 13 g/dL) before surgery, 55.7% of patients were in this high-risk category after preoperative autologous donation. The patients did not recover from the autologous donations that occurred 4 weeks before surgery. A mean hemoglobin level of 14.0 g/dL was seen before donation, whereas the mean preoperative hemoglobin level decreased to 12.6 g/dL. We think that a preoperative autologous donation program leads to an increased risk of anemia before surgery.
authors.affiliation: Beth Israel Medical Center, Singer Division, Department of Orthopaedics, Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, 170 East End Avenue, New York, NY 10128, USA. fcush@att.net
authors.forename: Fred D
authors.initials: FD
authors.lastname: Cushner
authors.forename: Thomas
authors.initials: T
authors.lastname: Hawes
authors.forename: Debra
authors.initials: D
authors.lastname: Kessler
authors.forename: Kala
authors.initials: K
authors.lastname: Hill
authors.forename: Giles R
authors.initials: GR
authors.lastname: Scuderi
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D001804:Blood Transfusion, Autologous; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period
chemical_list: D006454:Hemoglobins