ROLE OF AUTOLOGOUS BLOOD TRANSFUSION IN TOTAL KNEE REPLACEMENT SURGERY

Abstract

Introduction: Total Knee Replacement is a commonly done planned operative procedure frequently requiring blood transfusion. Fear of adverse reactions, transmission of viral illnesses like AIDS, Hepatitis B, C and Non A Non B has led to interest in alternatives to allogenic blood transfusion.

Predonation of autologous blood, administration of erythropoeitin alpha, postoperative blood recovery using cell saver or suction devices for reinfusion of whole blood have all been suggested to overcome this problem.

Aim: Our study was aimed to assess the efficacy of reinfusion of autologous blood transfusion from the blood collected after completion of the surgical procedure using Constavac reinfusion drain system.

Method: A prospective analysis of 54 patients undergoing primary total knee replacement was done. All patients with preoperative Hb of 12.5gm/dl or more were included. Postoperative drop in Hb below 9 gm/dl was an indication of supplemental transfusion. Probability of sepsis or malignancy were criterion for exclusion.

Results: In all patients undergoing Total knee replacement , average amount of blood reinfused was 480 mls. 50 of the 54 (92.6%) patients did not need any homologous blood transfusion. Average drop in Hb was 2.3 gm/dl. In nine patients (16.7%) there was drop in Hb of more than 3 gm% but only three of them needed blood transfusion. Patients with valgus deformity and needing lateral release were more at risk of needing homologous blood transfusion. No complications or adverse effects were noticed.

Discussion: Our study shows that reinfusion alone may be sufficient in most cases needing Total knee replacement. It is a reliable, safe, simple and cost effective way to overcome the need of allogenic blood transfusion in patients undergoing Total Knee Replacement. This may reduce the load on blood banks for cross matching all patients undergoing knee replacement except in valgus knees .