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IDENTIFICATION OF HIGH RISK GROUPS TO RECEIVE ALLOGENIC BLOOD IN PRIMARY HIP AND KNEE ANTHROPLASTY IS KEY TO CHANGE TRANSFUSION PRACTICE.

Département d'anesthésiologie, Centre Hospitalier Universitaire de Sherbrooke, 3001 12^ième avenue nord, Fleurimont, Qc J1H 5N4

INTRODUCTION

Allogenic blood is still commonly used in primary hip and knee arthroplasty. In any hospital, review of transfusion practices is one of the few ways clinicians have to change behaviour and propose clear alternatives to reduce the usage of allogenic blood. Effective use of blood needs collaborative effort involving many clinicians. Identifying groups of patients at high risk to receive allogenic blood according to his own institution practice is felt to be a key element in that process.

METHODS

This is a retrospective chart review of all elective primary hip and knee arthroplasty done during one year (February 1998 to March 1999) in our institution. All the redo cases were excluded. Data collection included many variables, including initial Hb (preop), use of autologous blood, perop blood loss, lowest postop Hb, Hb at discharge, use of allogenic blood, etc. Correlations between groups was done using 2 by 2 table with Chi Square and Fisher Exact P.

RESULTS

135 charts were reviewed, 79 (58%) hips and 56 (42%) knees. Mean age was 68.2, with an initial Hb of 132 gr/L. There were 77 women (57%) and 58 men (43%). Initial Hb < 120 gr/L was observed in 26 patients over 135, mostly women 20 over 77 (25%). The overall transfusion rate of allogenic blood was 50 over 135 (37%) patients.

Our autologous blood donation program was done in 39 patients (28%), 16 women over 77 (20%), and 23 men over 58 (39%). In the autologous program, 3 (18%) women over 16 (p <0.05) received allogenic blood compare to 32 (51%) women over 61 who did not; 23 men participate in the program, 2 received allogenic blood (p <0.05), and in 35 men who did not, 13 received allogenic blood. A total of 113 autologos blood units were collected and 58 units were wasted (51%).

108 allogenic blood units were used in 50 patients (2.16 units per patient). In 77 women, 20 had an initial Hb less than 120 gr/L with 14 (70%) (p <0.05) receiving allogenic blood, compared to 57 with an initial Hb greater than 120 gr/L and a transfusion rate of 36% (21 over 36).

95 patients had Hb at discharge lower that 100 gr/l, 43 lower than 90 and 13 lower than 80.

DISCUSSION

Two groups of patients at risk to reveive allogenic blood were identified: patients not participating in the autologous blood donation and patients with an initial low Hb (< 120 gr/L), those patients are mostly women and have a transfusion rate reaching 70%. Postoperative anemia is common in this population with a mean age of 68. Other alternatives to correct preop and postop anemia need to be used.

Our data are in line with previous studies.

REFERENCES

BE Bierbaum et al, An Analysis of Blood Management in Patients Having a Total Hip or Knee Arthroplasty, Journal of Bone and Joint Surgery, Vol.81-A, No1, Jan, 1999

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