title: A protocol avoiding allogeneic transfusion in joint arthroplasties.
abstract: BACKGROUND
  Arthroplasties of hip and knee are associated with blood loss, which may lead to adverse patient outcome. Performing arthroplasties in Jehovah's Witness patients who do not accept transfusion has been a matter of concern. We developed a protocol, which avoids transfusion in arthroplasties of Jehovah's Witness patients, and evaluated the feasibility and safety of the protocol.
  
  
  METHODS
  The target of preoperative hemoglobin was more than 10 g/dL. When preoperative hemoglobin was lower than 10 g/dL, 4000 U erythropoietin (3 times a week) and 100 mg iron supplement (every day) were administered until the hemoglobin reached 10 g/dL. When the preoperative hemoglobin was higher than 10 g/dL, 4000 U erythropoietin and 100 mg iron supplement were administered once, before operation. During the operation, cell saver was used. Postoperatively, erythropoietin and iron supplements were administered until the hemoglobin reached 10 g/dL, similar to the preoperative protocol. We evaluated the feasibility of our protocol, perioperative complications and hematologic changes.
  
  
  RESULTS
  From 2002 to 2014, 186 Witness patients visited our department. In 179 patients (96.2 %), 77 total knee arthroplasties, 69 bipolar hemiarthroplasties and 33 total hip arthroplasties were performed. The mean hemoglobin level was 12.3 g/dL preoperatively, 9.4 g/dL on postoperative day 3 and 10.3 g/dL on postoperative day 7. One patient died immediately after the arthroplasty and the remaining 178 patients survived.
  
  
  CONCLUSIONS
  Total joint arthroplasty could be done without transfusion using this protocol in most of our patients. The rates of infection and mortality were similar with known infection and mortality rates of arthroplasties. In patients who do not want allogeneic transfusions, our protocol is a safe alternative to perform joint arthroplasties.
authors.affiliation: Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea.
authors.forename: You-Sung
authors.initials: YS
authors.lastname: Suh
authors.affiliation: Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea. huuy@schmc.ac.kr.
authors.forename: Jae-Hwi
authors.identifier: http://orcid.org/0000-0003-1053-456X
authors.initials: JH
authors.lastname: Nho
authors.affiliation: Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea.
authors.forename: Hyung-Suk
authors.initials: HS
authors.lastname: Choi
authors.affiliation: Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, South Korea.
authors.forename: Yong-Chan
authors.initials: YC
authors.lastname: Ha
authors.affiliation: Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea.
authors.forename: Jong-Seok
authors.initials: JS
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, South Korea.
authors.forename: Kyung-Hoi
authors.initials: KH
authors.lastname: Koo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D002985:Clinical Protocols; D004921:Erythropoietin / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007501:Iron / Q000627:therapeutic use; D033221:Jehovah's Witnesses; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D007501:Iron
keywords: Arthroplasty; Hip; Knee; Transfusion