title: Targeted preoperative autologous blood donation in total knee arthroplasty reduces the need for postoperative transfusion.
abstract: BACKGROUND
  Preoperative donation of autologous blood has been widely used to minimize the potential risk of allogeneic transfusions in total knee arthroplasty. A previous study from our center revealed that preoperative autologous donation reduces the allogeneic blood exposure for anemic patients but has no effect for non-anemic patients.
  
  
  OBJECTIVE
  The current study investigates the impact of a targeted blood donation protocol on overall transfusion rates and the incidence of allogeneic blood transfusions.
  
  
  METHODS
  Prospectively, 372 patients undergoing 425 unilateral primary knee replacements were preoperatively screened by the Blood Preservation Center between 2009 and 2012. Anemic patients with a hemoglobin level less than 13.5 g/dL were advised to donate blood, while non-anemic patients did not donate.
  
  
  RESULTS
  Non-anemic patients who did not donate blood required allogeneic blood transfusions in 5.9% of the patients. The overall rate of allogeneic transfusion was significantly lower for anemic patients who donated autologous blood (group A, 9%) than those who did not donate (group B, 33%; p < 0.001). Donating autologous blood did increase the overall transfusion rate of anemic patients to 0.84 per patient in group A compared to 0.41 per patient in group B (p < 0.001).
  
  
  CONCLUSIONS
  This investigation confirms that abandoning preoperative autologous blood donation for non-anemic patients does not increase allogeneic blood transfusion rates but significantly lowers overall transfusion rates.
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Jad
authors.initials: J
authors.lastname: Bou Monsef
authors.forename: Johannes
authors.initials: J
authors.lastname: Buckup
authors.forename: David
authors.initials: D
authors.lastname: Mayman
authors.forename: Robert
authors.initials: R
authors.lastname: Marx
authors.forename: Amar
authors.initials: A
authors.lastname: Ranawat
authors.forename: Friedrich
authors.initials: F
authors.lastname: Boettner
keywords: allogeneic transfusion; anemia; blood management; preoperative autologous blood donation; total knee arthroplasty
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