title: Preoperative haematinics and transfusion protocol reduce the need for transfusion after total knee replacement.
abstract: BACKGROUND
  Unilateral total knee replacement (TKR) can result in a substantial blood loss and 30-50% of these patients receive allogeneic blood transfusion (ABT), this transfusion rate may be even higher among anaemic patients.
  
  
  METHODS
  We assessed the requirements for ABT in 156 consecutive patients undergoing surgery for primary TKR, who received iron ferrous sulphate (256 mg/day; 80 mg of Fe(2+)), vitamin C (1000 mg/day) and folic acid (5mg/day) during the 30-45 days preceding surgery, and who were transfused if Hb <80 g/L and/or clinical signs/symptoms of acute anaemia/hypoxemia (Group 2). A previous series of 156 TKR patients serves as a control group (Group 1).
  
  
  RESULTS
  Compared to those in Group 1, patients in Group 2 presented a lower transfusion rate (5.8% vs. 32%, for Group 2 and Group 1, respectively; p<0.01), and a lower transfusion index (1.78+/-0.44 vs. 2.22+/-0.65 units per transfused patient, respectively; p<0.05). After patient's stratification according to a preoperative Hb above or below 130 g/L, the differences in transfusion rate remained significant, although 19% of patients from Group 2 still needed ABT if their preoperative Hb <130 g/L.
  
  
  CONCLUSIONS
  This protocol seems to be effective for avoiding ABT in non-anaemic TKR patients, whereas for anaemic patients another blood saving strategy, such us preoperative erythropoietin administration or postoperative blood salvage, should be added to further increase its effectiveness.
authors: Department of Orthopaedic and Trauma Surgery, University Hospital Miguel Servet, Zaragoza, Spain.
authors: Jorge
authors: J
authors: Cuenca
authors: José A
authors: JA
authors: García-Erce
authors: Fernando
authors: F
authors: Martínez
authors: Rafael
authors: R
authors: Cardona
authors: Luís
authors: L
authors: Pérez-Serrano
authors: Manuel
authors: M
authors: Muñoz
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D001205:Ascorbic Acid / Q000008:administration & dosage; D001803:Blood Transfusion / Q000379:methods* / Q000706:statistics & numerical data; D004334:Drug Administration Schedule; D005260:Female; D005296:Ferrous Compounds / Q000008:administration & dosage*; D005492:Folic Acid / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006397:Hematinics / Q000008:administration & dosage*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D014815:Vitamins / Q000008:administration & dosage
chemical_list: D005296:Ferrous Compounds; D006397:Hematinics; D006454:Hemoglobins; D014815:Vitamins; C020748:ferrous sulfate; D005492:Folic Acid; D001205:Ascorbic Acid