A safe, simple and cost-effective protocol for blood transfusion in primary total knee replacement

Annals of the Royal College of Surgeons of England
A MehraC deAlwis

Abstract

Patients undergoing total knee replacement (TKR) in the UK usually have either blood cross-matched or have an auto-transfusion of drained blood postoperatively. A previous retrospective audit of blood requirements in patients who had undergone primary TKR showed that a large amount of cross-matched blood was wasted as the CT ratio (ratio of number of units of blood cross-matched to number of units transfused) of 4.9:1 was obtained. The range recommended by the Blood Transfusion Society is 2:1 to 3:1. A protocol was introduced to group and save plus antibody screen for all patients and to cross-match 2 units of blood pre-operatively in patients with either a haemoglobin of less than 12.5 g/dl or with multiple red cell antibodies in their blood. The trigger point for blood transfusion postoperatively was also reduced from 9.0 g/dl to 8.0 g/dl, unless the patient was clinically symptomatic. A further prospective study involving 50 patients was carried out using the new protocol. Five patients required cross-matching pre-operatively, three with haemoglobin less than 12.5 g/dl and two with multiple red cell antibodies. Postoperatively, the patients with haemoglobin of less than 12.5 g/dl required blood transfusion of 2 units each, r...Continue Reading

Citations

Aug 21, 2013·Paediatric Anaesthesia·Allison M FernándezEugenie S Heitmiller
Nov 18, 2017·Archives of Disease in Childhood·Jan HughesJohn W L Puntis
Mar 23, 2006·Annals of the Royal College of Surgeons of England·B A Rogers, D J Johnstone
Oct 21, 2014·Journal of Perioperative Practice·R F BamfordS A Black

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