title: Fibrin sealants or cell saver eliminate the need for autologous blood donation in anemic patients undergoing primary total knee arthroplasty.
abstract: BACKGROUND
  Reducing allogeneic blood transfusions remains a challenge in total knee arthroplasty. Patients with preoperative anemia have a particularly high risk for perioperative blood transfusions.
  
  
  METHODS
  176 anemic patients (Hb < 13.5 g/dl) undergoing total knee replacement were prospectively evaluated to compare the effect of a perioperative cell saver (26 patients), intraoperative fibrin sealants (5 ml Evicel, Johnson & Johnson Wound Management, Ethicon, Somerville, NJ) (45 patients), preoperative autologous blood donation (PABD) (21 patients), the combination of fibrin sealants and preoperative autologous blood donation (44) and no intervention (40 patients) on perioperative blood loss and transfusion requirements.
  
  
  RESULTS
  All protocols resulted in significant reduction of allogeneic blood transfusions. Transfusion rates were similar with the use of PABD (19%), Evicel (18%), and cell saver (19%), all significantly lower than the control group (38 %, p < 0.05). Combining Evicel with PABD resulted in significantly higher wastage of autologous units (p < 0.05) with no significant reduction in allogeneic transfusion rate (14%). The use of fibrin sealant resulted in a significant reduction of blood loss compared to the PABD group (603 vs. 810 ml, p < 0.005) as well as the control group (603 vs. 822 ml, p < 0.005).
  
  
  CONCLUSIONS
  While PABD proved to be the most cost-effective treatment option in anemic patients, fibrin sealants and cell saver show similar reduction in allogeneic transfusion rates compared to controls. The combination of fibrin sealants and PABD is not cost-effective and increases the number of wasted units.
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: Wenzel
authors.initials: W
authors.lastname: Waldstein
authors.forename: Charles
authors.initials: C
authors.lastname: Cornell
authors.forename: Friedrich
authors.initials: F
authors.lastname: Boettner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications / Q000628:therapy*; D019645:Arthroplasty, Replacement, Knee; D001782:Blood Donors; D016063:Blood Loss, Surgical; D001804:Blood Transfusion, Autologous / Q000379:methods*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D007592:Joint Diseases / Q000150:complications / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D015718:Fibrin Tissue Adhesive