A protocol avoiding allogeneic transfusion in joint arthroplasties.

Area of Science:

• Orthopedic Surgery
• Transfusion Medicine
• Patient Safety

Background:

• Arthroplasty procedures (hip and knee) are associated with significant blood loss.
• Jehovah's Witness patients decline blood transfusions, posing challenges for surgical management.
• Developing transfusion-free protocols is crucial for patient safety and ethical considerations.

Purpose of the Study:

• To evaluate the feasibility and safety of a novel protocol designed to avoid blood transfusions in Jehovah's Witness patients undergoing hip and knee arthroplasties.
• To assess perioperative complications and hematologic changes in patients managed with the transfusion-free protocol.

Main Methods:

• A protocol targeting a preoperative hemoglobin of >10 g/dL was implemented, utilizing erythropoietin and iron supplementation.
• Cell saver technology was employed during surgery.
• Postoperative erythropoietin and iron were administered to maintain adequate hemoglobin levels.

Main Results:

• The study included 179 Jehovah's Witness patients undergoing 77 total knee, 69 bipolar hip, and 33 total hip arthroplasties.
• Mean hemoglobin levels were 12.3 g/dL preoperatively, 9.4 g/dL on postoperative day 3, and 10.3 g/dL on postoperative day 7.
• One perioperative death occurred; 178 patients survived with no reported increase in infection or mortality rates.

Conclusions:

• Total joint arthroplasty can be safely performed without allogeneic blood transfusions in most Jehovah's Witness patients using the described protocol.
• The protocol demonstrated infection and mortality rates comparable to established arthroplasty benchmarks.
• This transfusion-free approach offers a safe alternative for patients who refuse blood transfusions.