Blood management experience: relationship between autologous blood donation and transfusion in orthopedic surgery.

Overview

Preoperative autologous donation (PAD) is commonly used for patients undergoing elective total joint arthroplasty; however, PAD is associated with increased overall transfusion rates and may not be cost-effective for all patients. A retrospective analysis was conducted on a series of 1405 patients undergoing unilateral or bilateral total hip or total knee arthroplasty at The Hospital for Special Surgery to determine the effect of PAD on transfusion outcomes. Eighty-three percent of patients predonated blood (1 unit to 3 units). Transfusions occurred in 82% of PAD participants and in only 50% of nondonors. The allogeneic transfusion rates were 8% for PAD participants and 50% for nondonors. Thirty-four percent to 45% of donated autologous units were discarded. Hemoglobin concentrations measured prior to surgery were inversely related to frequency of allogeneic transfusion. These data underscore the importance of hemoglobin levels in blood management planning. This information can be useful for formulating rational, cost-effective blood management guidelines.