title: Endorsing single-unit transfusion combined with a restrictive haemoglobin transfusion threshold after knee arthroplasty.
abstract: OBJECTIVE
  The utility of single-unit transfusions in the presence of restrictive haemoglobin transfusion thresholds is unknown.
  
  
  METHODS
  A prospective, pre-post intervention study was undertaken to evaluate a new transfusion strategy designed to reduce the rate of allogeneic transfusion and promote single-unit transfusion.
  
  
  METHODS
  Joint replacement centre within a public hospital.
  
  
  METHODS
  Patients undergoing primary unilateral knee arthroplasty (baseline, n=93; postintervention, n=347). OBJECTIVES OF THE INTERVENTION: Decrease the use of donor blood by (1) reducing the rate of donor transfusion and (2) endorsing the use of single-unit transfusion.
  
  
  METHODS
  A restrictive transfusion protocol was introduced, which included assessment of the need for transfusion based on haemoglobin value, and presence of signs, symptoms and comorbidity. Single or multiple units of blood were endorsed depending on the indication.
  
  
  METHODS
  Primary outcomes were transfusion rate; frequencies of attempted and successful single-unit transfusions. Secondary outcomes included 6-week haemoglobin and complications within 6 months postsurgery.
  
  
  RESULTS
  Transfusion rate significantly improved (41% (38/93) to 18% (64/347), chi(2) 21.3, p<0.001). The prescription of single units of blood (24% (9/38) to 33% (21/64), chi(2) 1, p=0.33) and successful single-unit transfusion (24% (9/38) vs 24% (15/64), chi(2)<0.01, p=1.0) were unchanged as were most secondary outcomes.
  
  
  CONCLUSIONS
  Restrictive haemoglobin thresholds are a safe, potent frontline strategy for decreasing the rate of blood transfusion. Judicious endorsement of single units is a secondary strategy for reducing the consumption of donor blood when the transfusion haemoglobin trigger is strict.
authors.affiliation: Whitlam Joint Replacement Centre, Fairfield Hospital, Sydney, New South Wales, Australia. justine.naylor@sswahs.nsw.gov.au
authors.forename: Justine M
authors.initials: JM
authors.lastname: Naylor
authors.forename: S
authors.initials: S
authors.lastname: Adie
authors.forename: M
authors.initials: M
authors.lastname: Fransen
authors.forename: S
authors.initials: S
authors.lastname: Dietsch
authors.forename: I
authors.initials: I
authors.lastname: Harris
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D001803:Blood Transfusion / Q000379:methods* / Q000592:standards; D002985:Clinical Protocols / Q000592:standards*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011446:Prospective Studies; D058996:Quality Improvement
chemical_list: D006454:Hemoglobins