title: Combined preoperative autologous blood donation and intra-operative cell salvage for hip surgery.
abstract: OBJECTIVE
  To review records of 161 consecutive hip surgery patients for whom preoperative autologous blood donation (PABD) was used in combination with intra-operative cell salvage (ICS).
  
  
  METHODS
  114 women and 14 men aged 41 to 86 (mean, 64) years underwent 135 primary total hip arthroplasties (THAs), whereas 19 women and 7 men aged 16 to 52 (mean, 35) years underwent 26 rotational acetabular osteotomies (RAOs). Two or 3 weeks before the operation, patients deposited one unit (400 ml) of blood weekly, so long as their haemoglobin levels exceeded 110 g/l (if they had osteoarthritis) or 100 g/l (if they had rheumatoid arthritis). Patients were given oral ferrous sulphate, lactated Ringer's solution, and recombinant human erythropoietin. 800 and 1200 ml of blood were deposited for patients undergoing THA and RAO, respectively. Intra-operatively, ICS was carried out using a continuous autotransfusion system. The blood from ICS was transfused first, and then the blood from PABD was transfused during the latter half of the operation.
  
  
  RESULTS
  By combining PABD and ICS, homologous blood transfusion was avoided in all patients, even in those with unexpected massive bleeding during surgery. In 3 patients, one unit of deposited autologous blood was discarded, because they showed no sign of anaemia. The mean total blood loss was almost 1.5 times higher in RAO than in THA patients (1095 vs 1550 ml). In the THA and RAO patients respectively, the mean amount of ICS was 181 and 210 ml, whereas the mean total blood transfusion volume was 975 and 1394 ml. No complications (including infection) related to autologous blood transfusion were observed during PABD, the surgery or the postoperative period.
  
  
  CONCLUSIONS
  Homologous blood transfusion was avoided with the use of PABD and ICS. Preoperative donation of 800 and 1200 ml of blood (combined with ICS) seemed optimal, as only 3 units of blood were discarded.
authors.affiliation: Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, Tokyo, Japan.
authors.forename: Reiko
authors.initials: R
authors.lastname: Kubota
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nozawa
authors.forename: Keiji
authors.initials: K
authors.lastname: Matsuda
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Maezawa
authors.forename: Sung-Gon
authors.initials: SG
authors.lastname: Kim
authors.forename: Kouichi
authors.initials: K
authors.lastname: Maeda
authors.forename: Takashi
authors.initials: T
authors.lastname: Ikegami
authors.forename: Kentarou
authors.initials: K
authors.lastname: Hayashi
authors.forename: Masataka
authors.initials: M
authors.lastname: Nagayama
authors.forename: Haruka
authors.initials: H
authors.lastname: Kaneko
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D016063:Blood Loss, Surgical; D001804:Blood Transfusion, Autologous; D002469:Cell Separation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D016896:Treatment Outcome