Postoperative autotransfusion after total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Transfusion Medicine
• Biochemistry

Background:

• Minimizing homologous blood transfusion is crucial in total knee arthroplasty (TKA).
• Autotransfusion systems aim to improve patient outcomes and reduce transfusion-related risks.
• Evaluating shed blood quality post-TKA is essential for safe autotransfusion.

Purpose of the Study:

• To assess the quality of shed blood after cemented TKA for autotransfusion.
• To determine the clinical safety of the Autovac autotransfusion system.
• To compare the effects of two different anticoagulants (calcium binding resin vs. acid citrate dextrose-A) on blood quality and safety.

Main Methods:

• The Autovac system was used for autotransfusion in 50 patients undergoing cemented TKA.
• Patients were divided into two groups based on the anticoagulant used: calcium binding resin (n=25) or acid citrate dextrose-A (ACD-A) (n=25).
• Fifteen hematologic parameters were measured over five time periods and compared to a control group (n=25) with standard drains.

Main Results:

• Autotransfusion with ACD-A was clinically safe.
• Blood collected with calcium binding resin showed significantly higher hemoglobin, plasma-free hemoglobin, and fibrin split products (P < .05).
• A statistically significant difference in white blood cell differential was observed in the calcium binding resin group.

Conclusions:

• Autotransfusion with the Autovac system using ACD-A is a safe and viable option for patients undergoing cemented TKA.
• The choice of anticoagulant significantly impacts the quality of autotransfused blood.
• Calcium binding resin may lead to undesirable changes in shed blood parameters compared to ACD-A.