Autologous Blood Donations Overused Says N.Y. Doc

“Patients not suffering from anemia before an operation do not need autologous blood donations prior to a primary knee or hip implantation, ” said Friedrich Böttner, of the Hospital for Special Surgery, New York. He was speaking at the 14th Congress of the European Federation of National Associations of Orthopaedics and Traumatology in Istanbul. “Instead, ” he added, “we should concentrate on blood management for patients whose preoperative hemoglobin level is too low.”

Böttner’s advice runs counter to the widespread practice of having autologous blood available during hip and knee replacement surgeries, according to the report in the International Congress for Joint Reconstruction (ICJR) article. In his remarks Böttner pointed out that the blood is generally not used and is then thrown away following the surgery. “This routine measure has not been medically indicated for a long time in all cases and often only leads to an increased transfusion rate, ” he said.

Böttner and his research team conducted a study. “In our study, we investigated the extent to which targeted use of banked blood affected the overall transfusion rate, ” he said. The investigators asked: how frequently do non- anemic patients actually need allogeneic blood transfusions? And how many bottles of blood do patients with a preoperative hemoglobin level of less than 13.5g/dL need?”

The research team analyzed data from more than 429 primary knee replacement procedures between 2009 and 2012. Only patients who were anemic were advised to donate their own blood. Nearly half of them—98 out of 233—did so. The majority of the 185 patients in the non-anemic group did not donate their own blood.

Only 13 of the 185 non-anemic patients (5.9%) needed an allogeneic blood transfusion during or after the procedure. Significantly more of the anemic subjects in the study did, including 33% of the patients from the anemic group who had not donated blood prior to surgery (44 out of 135 patients). The anemic group (98 patients) that had donated their own blood needed this blood in 71% of the cases.

Autologous blood donation proved highly effective for anemic patients and reduced the allogeneic blood required to 9%, according to the report. “Our findings are in accord with those in other research projects, ” said Böttner. “It is obvious that one can dispense with routine autologous blood donations prior to primary knee and also hip replacement procedures.”

“Targeted use of banked autologous blood is reasonable for both interventions only if patients suffer from anemia and therefore have an increased transfusion risk. Patients can spare themselves autologous blood donations if they have a preoperative hemoglobin level exceeding 12.5 g/dl prior to hip replacement and exceeding13.5 g/dL prior to knee replacement.”