[Analysis of a blood use list for orthopedic operations]

Is the documentation of blood utilisation, as demanded in the guidelines of serology and transfusion medicine, a proper instrument of quality control for the use of homologous blood saving techniques?

We analysed retrospectively a list of blood utilisation based on 12,482 surgical procedures in orthopaedic surgery. This list included the type of operation, the number of transfused packed red cell units and, if applicable, the type of homologous blood saving technique (preoperative blood donation, mechanical autotransfusion and isovolaemic haemodilution). Total hip and knee replacement patients were divided in two groups according to base line haemoglobin (A: Hb > 13 mg%, B: hB < or = 13 mg%).

The increase of the percentage of patients not receiving homologous blood achieved by blood saving techniques is more pronounced in group B. Preoperative blood donation seems to be the most effective technique with a percentage of patients not receiving homologous blood of 93% in group A and 80% in group B of total hip replacement. This high percentage cannot be improved when preoperative blood donation is combined with mechanical autotransfusion or isovolaemic haemodilution. The efficiency of mechanical autotransfusion and isovolaemic haemodilution can be improved by combination of the two techniques.

A list of blood utilisation as presented can serve as a basis for guidelines regarding the use of homologous blood saving techniques. Moreover such a simple statistic provides a means of quality control and provides information about the likelihood of transfusion.