Blood transfusion and deep venous thrombosis in primary total hip and knee replacement surgery: a retrospective analysis of 339 patients.

Autologous blood transfusion (ABT) has become widely practiced as a useful procedure in preventing the side effects of allogeneic blood transfusion (allo-BT) and in coping with a cost-containment policy. We report on a retrospective analysis of blood support of 339 patients undergoing orthopedic elective surgery in the period 1988-1994. We observed a progressive decrease of allo-BTs (from 54.5 to 14.8% in males and from 73.7 to 15.5% in females undergoing total hip replacement), and assessed the usefulness of post-operative blood salvage in reducing the need for allo-BT when a concomitant pre-deposit program is conducted. In addition, we carefully reviewed charts in order to establish Deep Venous Thrombosis (DVT)-related morbidity, and found a surprisingly low incidence (only 3.2%) of this dreadful complication in our patient series. It is yet to be established whether anticoagulant prophylaxis and early mobilization are strongly effective in preventing DVT, or that many DVTs happen after hospital discharge and are not identified and/or reported to the orthopedic team.

Impact of autologous blood transfusion on blood support in general thoracic surgery: analysis of 969 patients over a 5-year period.

Autologous blood transfusion (ABT) is increasingly used in order to avoid transfusion-related risks. The effectiveness of this simple and feasible procedure depends on several factors, such as the timing of surgery, the patient's overall condition and, last but not least, the pre-disposition of the medical team towards the routine use of ABT. We report our experience in blood support with ABT for general thoracic surgical patients, indicating an overall partially satisfactory outcome due to a limited use of the procedure. In 1992, 61 patients (38%) received autologous blood only, as compared to 9 patients (6%) who had received ABT in 1989. The average pre-deposit per patient ratio in 1992 was 1.2 units, which provided insufficient autologous blood support. In the same period, only 23 patients were subjected to acute normovolemic hemodilution (ANH). However, we noted a reduction of homologous transfusions from 2.9 +/- < 2.1 in 1989 to 2.0 +/- < 1.5 in 1992 (P < 0.01). In addition, we observed that a single pre-deposit was not enough to enhance erythropoiesis and to improve post-operative red blood cell rescue when performed in patients with Hb > 11 g%. Based on our data, we emphasize a more extensive move to ANH, along with pre-deposit, in order to avoid unnecessary homologous blood transfusions.