Aim: To audit blood transfusion practice in primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA) after introduction of more stringent blood transfusion criteria.

Methods: A retrospective survey was carried out for all THR and TKR. Data was collected over a period of four months with a blood transfusion criteria of haemoglobin (Hb) concentration of 8.0 g/dl and below. This was compared against a three month period after the reduction in the blood transfusion criteria to a Hb concentration of 7.0 g/dl and below. An analysis of all pre-operative and post-operative (day-2 post-op) Hb concentrations was performed. The post-transfusion Hb concentration was recorded 1-day post transfusion.

Results: A total 539 TKA and 521 THA were performed. Following the new blood transfusion protocol the rate of blood transfusion was significantly reduced from 9.4% to 3.6% for TKA, and from 28% to 12.8% for THA.

Conclusion: A significant reduction in transfusion rates is achieved in TKA and THA by introduction of a Hb concentration 7.0 g/dl as a trigger for blood transfusion. This new trigger is based on the current body of evidence available and is integrated in to well defined care pathway. A 50% reduction in donated blood is predicted in the UK in 2007 if vCJD testing is enforced. We feel early redressing of blood transfusion practice in the UK is advised if we are to avoid a catastrophic reduction in our TKA and THA capacity.