Blood saving protocol in elective total knee arthroplasty.

Area of Science:

• Orthopedic Surgery
• Transfusion Medicine
• Anesthesiology

Background:

• Allogeneic blood transfusions pose risks and challenges in elective orthopedic procedures.
• Developing effective blood management strategies is crucial for patient safety and resource optimization.
• Elective total knee arthroplasty (TKA) is a common procedure with a significant potential for blood loss.

Purpose of the Study:

• To evaluate the efficacy of a combined protocol for minimizing allogeneic blood transfusions in TKA.
• To assess the safety and applicability of the implemented blood-saving measures.
• To compare transfusion rates before and after the protocol's introduction.

Main Methods:

• The protocol combined perioperative human recombinant erythropoietin with iron and folic acid.
• It included mild acute normovolemic hemodilution and meticulous surgical techniques.
• Postoperative blood salvage via a closed-wound drainage system and lower transfusion triggers were also employed.

Main Results:

• Only 5 out of 61 patients (8.2%) required allogeneic blood transfusion under the protocol.
• This contrasts with 50 out of 58 patients (86.2%) requiring 111 units before the protocol.
• Allogeneic blood utilization decreased by 94%, a statistically significant improvement (P < 0.001).

Conclusions:

• The combined protocol is highly effective in reducing allogeneic blood transfusions in TKA.
• The protocol is characterized by safety and ease of application for orthopedic surgeons.
• This blood-saving strategy should be considered a valuable option for elective total knee arthroplasty.