Blood management protocol for baseline anemic patients undergoing hip arthroplasty

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Hematology

Background:

• Preoperative anemia in total hip arthroplasty (THA) patients increases transfusion risk.
• Patient blood management (PBM) protocols aim to reduce perioperative transfusions.
• This study assesses a PBM protocol's efficacy in THA patients with preoperative anemia.

Purpose of the Study:

• To evaluate the effectiveness and safety of a PBM protocol in elective primary THA patients with preoperative anemia.
• To compare blood loss and transfusion rates between anemic and non-anemic THA patients.
• To determine if optimizing hemoglobin levels above 12 g/dL is necessary for THA patients.

Main Methods:

• Retrospective analysis of a prospectively collected THA database (January 2013 - October 2023).
• Patients grouped by baseline hemoglobin (Hb): <12 g/dL (group 1) and ≥12 g/dL (group 2).
• PBM protocol included preoperative epoetin (EPO) for Hb <11 g/dL, bleeding reduction, and restrictive transfusion thresholds; blood loss measured by BI-7.

Main Results:

• 1,442 THA patients analyzed; 104 (7%) had Hb <12 g/dL (group 1).
• 46% of group 1 received EPO; none required transfusion in the first week.
• Mean adjusted BI-7 was significantly lower in group 1 (2.3 g/dL) vs. group 2 (2.7 g/dL), indicating less blood loss (p < 0.001).

Conclusions:

• THA patients with baseline Hb <12 g/dL achieved a zero-transfusion rate and lower blood loss.
• Optimizing preoperative Hb levels above 12 g/dL is not essential for standard THA.
• The PBM protocol effectively conserved blood, time, and resources, offering a viable blood conservation strategy.