Abstract
Introduction
Arthroplasties of hip and knee are associated with blood loss, which may lead to adverse patient outcome. Jehovah's Witnesses do not accept blood transfusion. Performing arthroplasties in Witness patients without transfusion has been a matter of concern. We developed a protocol, which avoids transfusion in arthroplasties of Witness patients, and evaluated the feasibility and safety of the protocol.
Materials and Methods
Our protocol consisted of subcutaneous administration of 4000 U recombinant erythropoietin and 100 mg of intravenous iron supplements when patient's hemoglobin level was less than 10 g/dL in preoperative evaluation. During the operation, cell saver, and plasma expander were used. Postoperatively, recombinant erythropoietin was administered three times a week and iron supplements were administered daily until the hemoglobin level reached 10 g/dL. We evaluated the feasibility of our protocol, perioperative complications and hematologic changes.
Results
From March 2002 to December 2014, 179 Jehovah's Witness patients(232 cases) visited our department to receive hip or knee arthroplasty. The 225 arthroplasties were successfully performed using the protocol without any transfusion. Thus, the feasibility of our protocol in patients, who refused transfusion, was 97.0%. 46 bilateral patients who received second arthroplasty was excluded for statistical independency. The mean age at the time of surgery was 70.7 years. Total 179 arthroplasties were included in this study. The types of joint arthroplasty included 77 total knee arthroplasties, 69 bipolar hemiarthroplasties of the hip and 33 total hip arthroplasties. The mean hemoglobin level was 12.3 g/dL preoperatively, which decreased to 9.4 g/dL during the first 3 days after the operation. After then, the level gradually recovered and reached to 10.3 g/dL on postoperative day 7. Thus, the mean decrease of hemoglobin level was 2.0 g/dL (16.3%) as of seven days after the operation. One patient had pulmonary embolism. The remaining 179 patients survived the procedure and were discharged from the hospital. Two patients had symptomatic DVT. Two patients (1.1%) died within 90 days after the operation: one due to myocardial infarct and the other due to gastrointestinal bleeding. Periprostheitic joint infection developed in 2 patients (1.1%).
Conclusion
Joint arthroplasty could be done without transfusion using the protocol in most of our patients. The hemoglobin level was stable during and after the arthroplasty. We did not find complications related with our protocol. The rates of infection and mortality were similar with known infection and mortality rates of arthroplasties. In patients who do not want allogeneic transfusions, our protocol is a safe alternative to perform joint arthroplasty.
