Use of preoperatively deposited autologous blood for total knee replacement

The efficacy of obviating homologous blood transfusion by an autologous blood program was investigated prospectively in a series of patients undergoing total knee replacement. Seventy-nine patients who underwent 110 consecutive total knee replacement operations (66 unilateral and 22 one-stage bilateral procedures) from 1986 to 1990 were studied. All patients who had elective procedures (86 of the 88 procedures) were encouraged to donate autologous blood prior to surgery if there were no medical contraindications. Seventy-six percent of the elective procedures (65 of 86) were done in patients who deposited autologous blood preoperatively. Homologous transfusion was required after only two of these 65 procedures (3%) in patients who predeposited autologous blood. This frequency of homologous transfusion was an order of magnitude lower than the frequency of homologous transfusion (35%) after procedures in patients who did not predeposit blood. Overall, 89% of the entire series of 88 procedures were performed in patients who received only autologous blood and 94% of the total volume of blood given after these 88 procedures was autologous. The Cell Saver was successful in salvaging an average of 287 mL of red blood cells per procedure after 36 procedures, but was not successful in saving blood after 29 others. The authors conclude that preoperatively deposited autologous blood is effective in reducing the need for homologous transfusion to patients who undergo elective total knee replacement.