Prior deposition of autologous blood in elective orthopaedic surgery

We retrospectively analyzed a program of prior deposit and storage of autologous blood that was used for patients who underwent elective orthopaedic procedures over a period of thirty-six months at the Walter Reed Army Medical Center. Of a total of 211 patients who underwent total joint replacement or spinal fusion during this period and who had sufficient records to be included in the study, a total of 159 patients enrolled in the program. The fifty-two patients who did not enroll in the study, twelve of whom were rejected because of medical problems, served as a control group. Since the preoperative hematocrit values for patients in the group that received autologous blood were similar to those for the control group, multiple preoperative phlebotomies in these patients, who had received supplemental iron, did not seem to have any deleterious effects. One hundred and thirteen (71 per cent) of the 159 patients who were enrolled in the program received only autologous blood. The remaining forty-six patients required homologous blood also, but 64 per cent of their transfusion needs were provided by autologous blood. The only reactions to the transfusions in the study were in four patients who received homologous blood. We think that a program of prior deposit and storage of autologous blood should be an option for patients who are to undergo elective orthopaedic surgery. Such a program is well tolerated by the patients and easily managed by the staff, and it was not difficult to implement at our tertiary referral hospital.