Patient Blood Management in Hip Replacement Arthroplasty / 대한고관절학회지

Perioperative blood transfusions are common in total hip arthroplasty because of preoperative anemia and perioperative blood loss. Perioperative anemia and the need for allogeneic blood transfusion are related with increased morbidity. To reduce perioperative allogeneic blood transfusion, keeping the preoperative hemoglobin level above 12.0 g/dL is important in orthopedic patients. By using the anti-fibrinolytic agent or perioperative cell salvage, reduce intraoperative blood loss is very important for the reduction of perioperative blood loss. As a transfusion trigger, low hemoglobin is another important target to reduce the transfusion rate. Because blood management is closely connected with prognosis, it has become a new challenge in orthopedic surgery.

An Autotransfusion Device Reduces the Amount of Allogenic Transfusion in Bilateral Sequential Total Knee Arthroplasty

PURPOSE: This study examined the difference in the reduction of the amount of required allogenic transfusion after bilateral total knee arthroplasty when an autotransfusion device was used. MATERIALS AND METHODS: The subjects were ninety five patients who underwent sequential bilateral total knee arthroplasty from January 2006 to May 2010 by one surgeon. The first group was 50 patients who did not have an autotransfusion device used and second group of 45 patients were those who had an autotransfusion device used during the postoperative period. Group 1 received allogenic blood transfusion with a standard level of postoperative hemoglobin. The group 2 patients were reinfused with as much blood as was collected by an autotransfusion suction bag and then they received allogenic blood transfusion with a standard level of postoperative hemoglobin. RESULTS: The total blood loss and amount of blood transfusion were almost the same in the two groups. The mean amount of allotransfusion was 1,270.0 mL in group 1 and 564.4 mL in group 2 and the reduced amount of allotransfusion in group 2 was statistically significant (p<0.05). CONCLUSION: Using an autotransfusion device is a good method to reduce the mean amount of allotransfusion after bilateral sequential total knee arthroplasty.

Effect of Acute Normovolemic Hemodilution on Homologous Blood Saving during Off-Pump CABG / 대한마취과학회지

BACKGROUND: Acute normovolemic hemodilution (ANH) is accepted to be the easiest and most economical method of autotransfusion. This study was performed to investigate the clinical usefulness of ANH in patients undergoing off-pump CABG. METHODS: Thirty patients were randomly divided into two groups. In the ANH group, 753.3 +/- 51.6 ml of fresh autologous whole blood were sequestrated from a pulmonary artery catheter following induction of anesthesia with simultaneous infusion of colloids and crystalloid solution from a separate line. Perioperative changes of hemoglobin, hematocrit level, platelet counts, prothrombin time, cardiac output, transfusion requirement and the amount of postoperative drainage were compared between the two groups. RESULTS: Perioperative changes of platelet counts and PT showed no significant differences between the two groups. Less allogenic blood was used in the ANH group (0.27 +/- 0.46 unit) than in the control group (1.27 +/- 0.80 unit) in the operation room. CONCLUSIONS: ANH can decrease the transfusion requirement in off-pump CABG.