title: Allogeneic blood transfusion reduction by risk-based protocol in total joint arthroplasty.
abstract: OBJECTIVE
  To evaluate the effect of a preoperative protocol that triages patients awaiting total joint arthroplasty to one of four strategies designed to mitigate the risk of allogeneic blood transfusion (ABT) based on a priori transfusion risk on perioperative exposure to allogeneic blood.
  
  
  METHODS
  We compared the transfusion experiences of a historical control series of 160 subjects with a study group of 160 subjects treated by protocol. Protocol subjects with hemoglobin (Hb) 100-129 g.L(-1) were given erythropoietin, dosed by weight. Subjects with Hb 130-139 g.L(-1) underwent preoperative autologous blood harvest and perioperative re-infusion as deemed clinically necessary. Subjects with Hb >139 g.L(-1) received no special intervention, unless they were aged >70 yr and weighed < 70 kg, in which case they received oral iron and folate supplementation.
  
  
  RESULTS
  The relative risk of ABT in the Study group was 0.68 (95% confidence interval 0.54-0.85). The Control group received 104 units of allogeneic blood and the Study group received 35 units (P = 0.0007). These differences cannot be explained by differences in transfusion risk or autologous units transfused. There was no worsening of anemia or its consequences in the Study group.
  
  
  CONCLUSIONS
  A simple protocol based on easily obtained preoperative clinical indices effectively targets interventions that mitigate the risk of ABT.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada. srashiq@ualberta.ca
authors.forename: Saifudin
authors.initials: S
authors.lastname: Rashiq
authors.forename: Kathryn
authors.initials: K
authors.lastname: Jamieson-Lega
authors.forename: Carolyn
authors.initials: C
authors.lastname: Komarinski
authors.forename: Susan
authors.initials: S
authors.lastname: Nahirniak
authors.forename: Lisa
authors.initials: L
authors.lastname: Zinyk
authors.forename: Barry
authors.initials: B
authors.lastname: Finegan
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000379:methods; D001803:Blood Transfusion / Q000379:methods; D002985:Clinical Protocols; D004921:Erythropoietin / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D065227:Transfusion Reaction; D014182:Transplantation, Autologous / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014218:Triage / Q000379:methods
chemical_list: D006454:Hemoglobins; D004921:Erythropoietin