Allogeneic blood transfusion reduction by risk-based protocol in total joint arthroplasty.
Study Goal
To evaluate the effectiveness of a preoperative protocol using iron and other interventions to reduce the risk of allogeneic blood transfusion in patients undergoing total joint arthroplasty.
Results Summary
The study found that the protocol significantly reduced the risk of allogeneic blood transfusion (relative risk 0.68) and decreased the number of units transfused (35 vs. 104 in the control group). There was no worsening of anemia or its consequences in the study group.
Population
Patients awaiting total joint arthroplasty with varying hemoglobin levels (100-139 g/L).
Effective Dosage
Oral iron and folate supplementation (specific dosage not mentioned).
Duration
Preoperative period (exact duration not specified).
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
preoperative protocol triaging patients to one of four strategies based on transfusion risk | decrease | risk of allogeneic blood transfusion (ABT) | patients awaiting total joint arthroplasty | - | effectively targets interventions that mitigate the risk | #1 |
erythropoietin, dosed by weight | neutral | hemoglobin (Hb) 100-129 g.L(-1) | protocol subjects | - | given | #2 |
preoperative autologous blood harvest and perioperative re-infusion | neutral | hemoglobin (Hb) 130-139 g.L(-1) | protocol subjects | - | underwent | #3 |
oral iron and folate supplementation | neutral | hemoglobin (Hb) >139 g.L(-1), aged >70 yr and weighed < 70 kg | protocol subjects | - | received | #4 |
preoperative protocol | decrease | relative risk of ABT | Study group | 0.68 (95% confidence interval 0.54-0.85) | reduced | #5 |
preoperative protocol | decrease | units of allogeneic blood received | Study group | 35 units vs 104 units in Control group (P = 0.0007) | reduced | #6 |
preoperative protocol | no change | anemia or its consequences | Study group | - | no worsening | #7 |
PURPOSE: To evaluate the effect of a preoperative protocol that triages patients awaiting total joint arthroplasty to one of four strategies designed to mitigate the risk of allogeneic blood transfusion (ABT) based on a priori transfusion risk on perioperative exposure to allogeneic blood. METHODS: We compared the transfusion experiences of a historical control series of 160 subjects with a study group of 160 subjects treated by protocol. Protocol subjects with hemoglobin (Hb) 100-129 g.L(-1) were given erythropoietin, dosed by weight. Subjects with Hb 130-139 g.L(-1) underwent preoperative autologous blood harvest and perioperative re-infusion as deemed clinically necessary. Subjects with Hb >139 g.L(-1) received no special intervention, unless they were aged >70 yr and weighed < 70 kg, in which case they received oral iron and folate supplementation. RESULTS: The relative risk of ABT in the Study group was 0.68 (95% confidence interval 0.54-0.85). The Control group received 104 units of allogeneic blood and the Study group received 35 units (P = 0.0007). These differences cannot be explained by differences in transfusion risk or autologous units transfused. There was no worsening of anemia or its consequences in the Study group. CONCLUSION: A simple protocol based on easily obtained preoperative clinical indices effectively targets interventions that mitigate the risk of ABT.