title: Silent myocardial ischaemia and haemoglobin concentration: a randomized controlled trial of transfusion strategy in lower limb arthroplasty. Intraoperative Autotransfusion in Hip Arthroplasty Autologous blood transfusion in total knee replacement surgery. The utility of the perioperative autologous transfusion system OrthoPAT® in total hip replacement surgery: a prospective study Perioperative intravenous iron, with or without erythropoietin, plus restrictive transfusion protocol reduce the need for allogeneic blood after knee replacement surgery. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Effect of autologous salvaged blood on postoperative natural killer cell precursor frequency Efficacy, safety and user-friendliness of two devices for postoperative autologous shed red blood cell re-infusion in elective orthopaedic surgery patients: A randomized pilot study. The effectiveness of reinfusion after total knee replacement. A prospective randomised controlled study Benefits of postoperative shed blood reinfusion in patients undergoing unilateral total knee replacement Comparative analysis of the benefits of autotransfusion of blood by a shed blood collector after total knee replacement The effect of universal leukoreduction on postoperative infections and length of hospital stay in elective orthopedic and cardiac surgery. Autotransfusion drains in total knee replacement. Are they alternatives to homologous transfusion? Oral iron therapy for anaemia after orthopaedic surgery: randomized clinical trial Prospective randomized evaluation of blood salvage techniques for primary total hip arthroplasty. Closed wound drainage in total hip or total knee replacement. A prospective, randomized study. A prospective comparison of clamping the drain or post-operative salvage of blood in reducing blood loss after total knee arthroplasty. Increased interleukin-6 in collected drainage blood after total knee arthroplasty: An association with febrile reactions during retransfusion Prospective comparative study of two different autotransfusion methods versus control group in total knee replacement Risk for postoperative infection after transfusion of white blood cell-filtered allogeneic or autologous blood components in orthopedic patients undergoing primary arthroplasty. The clinical advantages of autologous transfusion. A randomized, controlled study after knee replacement. A prospective randomised controlled trial of autologous retransfusion in total knee replacement. Complement split products and pro-inflammatory cytokines in salvaged blood after hip and knee arthroplasty The use of a closed-suction drain in total knee arthroplasty. A prospective, randomised study. Retransfusion of filtered shed blood in primary total hip and knee arthroplasty: a prospective randomized clinical trial. Clinical efficacy of postoperative autologous transfusion of filtered shed blood in hip and knee arthroplasty. Comparison of closed-suction drainage and no drainage after primary total knee arthroplasty. Perioperative red blood cell transfusion and outcome in stable patients after elective major vascular surgery.
abstract: BACKGROUND AND OBJECTIVES Red cell transfusion is commonly used in orthopaedic surgery . Evidence suggests that a restrictive transfusion strategy may be safe for most patients . However , concern has been raised over the risks of anaemia in those with ischaemic cardiac disease .  Perioperative silent myocardial ischaemia ( SMI ) has a relatively high incidence in the elderly population undergoing elective surgery . This study used Holter monitoring to compare the effect of a restrictive and a liberal red cell transfusion strategy on the incidence of SMI in patients without signs or symptoms of ischaemic heart disease who were undergoing lower limb arthroplasty . MATERIAL S AND METHODS We performed a multicentre , controlled trial in which 260 patients undergoing elective hip and knee replacement surgery were enrolled and r and omized to transfusion triggers that were either restrictive ( 8 g/dl ) or liberal ( 10 g/dl ) . Participants were monitored with  continuous ambulatory electrocardiogram ( ECG ) ( Holter monitoring ) , preoperatively for 12 h and postoperatively for 72 h. The tapes were analysed for new ischaemia by technicians blinded to treatment . The total ischaemia time in minutes was divided by the recording time in hours and an ischaemic load in min/h was calculated . Haemoglobin levels were measured preoperatively , postoperatively in the recovery room , and on days one , three and five after surgery . RESULTS The mean postoperative haemoglobin concentration was 9.87 g/dl in the restrictive group and 11.09 g/dl in the liberal group . In the restrictive group , 34 % were transfused a total of 89 red cell units , and in the liberal group 43 % were given a total of 119 red cell units . A postoperative episode of silent ischaemia was experienced by 21/109 ( 19 % ) patients in the restrictive group and by 26/109 ( 24 % ) patients in the liberal group [ mean difference -4.6 % ; 95 % confidence interval ( CI ) : -15.5 % to 6 % , P = 0.41 ) . There was no significant difference ( P = 0.53 ) between the overall ischaemic load in the restrictive group ( median 0 min/h , range 0 - 4.18 ) and the liberal group ( median 0 min/h , range 0 - 19.48 ) . In those patients who did experience postoperative SMI , the mean ischaemic load was 0.48 min/h in the restrictive group and 1.51 min/h in the liberal group ( ratio 0.32 , 95 % CI : 0.14 - 0.76 , P = 0.011 ) . The median postoperative length of hospital stay in the restrictive group was 7.3 days [ range 5 - 11 ; interquartile range ( IQR ) 6 - 8 ] compared with 7.5 days ( range 5 - 13 ; IQR 7 - 8 ) in the liberal group . The numbers were not large enough to conclude equivalence . CONCLUSIONS In patients without preoperative evidence of myocardial ischaemia undergoing elective hip and knee replacement surgery , a restrictive transfusion strategy seems unlikely to be associated with an increased incidence of SMI . A proportion of these patients experience moderate SMI , regardless of the transfusion trigger . Use of a restrictive transfusion strategy did not increase length of hospital stay , and use of this strategy would lead to a significant reduction in red cell transfusion in orthopaedic surgery . Our data did not indicate any potential for harm in employing such a strategy in patients with no prior evidence of cardiac ischaemia who were undergoing elective orthopaedic surgery Two groups of patients having primary or revision total hip replacement were studied during a period of 11 months . The first group of 40 consecutive patients consented to have whole blood collected coincident with acute normovolemic hemodilution . An inventory of autologous red blood cells , plasma , and platelets was prepared in the operating room as a preliminary to surgery . Subsequently , the same supplies and equipment were used for autotransfusion intraoperatively . In a case-control study , another 40 patients having total hip replacements were matched for age , gender , and weight . The second group of patients refused hemodilution and received autotransfusion alone . The perioperative transfusion requirements of the two groups were compared . The total blood product donor exposure rate of the first group was ¼ of the controls ( 0.6 and 2.4 donor units per patient , respectively ) . The average length of stay in the hospital after surgery for the first group was shortened significantly ( 6.2 versus 8.4 days ) , possibly from less immunogenic insult associated with increased transfusions of autologous blood products . Hemodilution , followed by autotransfusion , was cost effective in primary and revision total hip replacements , autotransfusion alone was cost effective only in revision arthroplasty BACKGROUND / AIM Total knee replacement ( TKR ) surgery is one of the most frequent and the most extensive procedures in orthopedic surgery , accompanied with some serious complications . Perioperative blood loss is one of the most serious losses , so it is vital to recognize and treat such losses properly . Autologous blood transfusion is the only true alternative for the allogeneic blood . The aim of this study was to to examine if autologous blood transfusion reduces usage of allogenic blood in total knee replacement surgery , as well as to examine possible effect of autologous blood transfusion on postoperative complications , recovery and hospital stay of patients after total knee replacement surgery . METHODS During the controlled , prospect i ve , r and omised study we compared two groups of patients ( n = 112 ) with total prosthesis implanted in their knee . The group I consisted of the patients who received the transfusion of other people 's ( allogeneic ) blood ( n = 57 ) and the group II of the patients  whose blood was collected postoperatively and then given them [ their own ( autologous ) blood ] ( n = 55 ) . The transfusion trigger for both groups was hemoglobin level of 85 g/L. RESULTS In the group of patients whose blood was collected perioperatively only 9 ( 0.9 % ) of the patients received  transfusion of allogeneic blood , as opposed to the control group in which 98.24 % of the patients received the transfusion of allogeneic blood ( p < or = 0.01 ) . The patients whose blood was collected stayed in hospital for 6.18 days , while the patients of the control group stayed 7.67 days ( p < 0.01 ) . CONCLUSION Autologous blood transfusion is a very effective method for reducing consumption of allogenic blood and thus , indirectly for reducing all complications related to allogenic blood transfusion . There is also a positive influence on postoperative recovery after total knee replacement surgery due to the reduction of hospital stay , and indirectly on the reduction of hospital costs Background Total hip replacement ( THR ) is associated with a significant perioperative blood loss , and 30–50 % of these patients receive allogeneic blood transfusion ( ABT ) . We evaluated the clinical utility of washed shed blood ( WSB ) return to reduce ABT in THR patients . Study design and methods Data from 108 consecutive THR patients were prospect ively collected .  WSB salvage and reinfusion ( OrthoPAT ) was intended for 60 ( Reinfusion group ) , whereas the remaining 48 patients served as control group . Patients received ABT if haemoglobin < 8 g/dl or clinical signs and symptoms of acute anemia . Results WSB return was possible in 49 patients ( 205 ± 151 ml of erythrocyte/patient ) , without any clinical ly relevant incident . Return of WSB decreased both the ABT rate ( 48 vs. 15 % , for control and reinfusion groups , respectively ; P = 0.001 ) and the ABT index ( 371 ± 154 ml RBC vs. 53 ± 117 ml RBC , respectively ; P = 0.001 ) , without differences between cemented and uncemented THR . In addition , patients from reinfusion group showed a trend to lower postoperative infection rate ( 10 vs. 2 % , respectively ; P = 0.086 ) . Conclusions Perioperative salvage and return of WSB in THR seems to effectively reduce the requirements for ABT . However , for patients with preoperative Hb < 13 g/dl , some additional blood saving method should be associated to WSB return BACKGROUND Unilateral total knee replacement ( TKR ) results in a substantial blood loss and 30 to 50 percent of patients receive allogeneic blood transfusion ( ABT ) . Therefore , the effectiveness of a restrictive transfusion trigger ( hemoglobin [ Hb ] level < 8 g/dL ) plus stimulation of erythropoiesis was evaluated , with or without blood salvage , for reducing ABT in TKR patients . STUDY DESIGN AND METHODS A series of 139 consecutive of primary TKR patients received perioperative iron sucrose ( 2 x 200 mg/48 hr , intravenously [ IV ] ) , plus preoperative erythropoietin ( EPO ; 1 x 40.000 UI , sc ) if preoperative Hb level was less than 130 g per L ( Group A ) . This protocol was applied to another series of 173 consecutive TKR patients who also received postoperative unwashed shed blood ( USB ) if preoperative Hb level was less than 130 g per L ( Group B ) . Perioperative clinical and laboratory data were gathered . RESULTS No adverse effects of iron sucrose , EPO , or USB administration were witnessed , and only 13 patients received ABT overall ( 4 % ) . No major differences in perioperative blood counts or iron metabolism variables were observed between groups , but stimulation of erythropoiesis seemed to be more pronounced in those patients receiving EPO ( p < 0.05 ) . There were no differences in postoperative complications between groups , but length of hospital stay for patients with a preoperative Hb level of less than 130 g per L was shorter in Group B ( p < 0.05 ) . CONCLUSION This blood saving protocol seems to be effective for reducing ABT in TKR patients . Which patients are more likely to benefit from either perioperative iron administration or selective addition of postoperative blood salvage to pharmacologic treatment , however , needs to be further evaluated BACKGROUND The purpose of this study was to assess current practice s in blood management in elective orthopedic surgery in Europe . STUDY DESIGN AND METHODS For this 225-center prospect i ve survey , data were collected on 3996 patients .  Actual perioperative blood loss was compared to preoperative estimates . Differences in Hb levels and other outcome variables for patients receiving allogeneic versus autologous transfusions  were evaluated . The probability of allogeneic transfusion  based on selected predictor variables was estimated . RESULTS A total of 2640 ( 67 % ) hip and 1305 ( 33 % ) knee arthroplasty patients were evaluated .  Estimated blood loss ( median , 750 mL ) was significantly lower than computed blood loss ( median , 1944 mL ) . A total of 2762 ( 69 % ) patients received  transfusions  , including 1393 ( 35 % ) autologous-only and 1024 ( 25 % ) allogeneic-only . The probability of allogeneic transfusion  decreased with increasing baseline Hb , but differentially so for men and women . Transfusion triggers were Hb levels of 8.93 + /- 1.83 g per dL for allogeneic transfusions , and 21 percent of these occurred when the Hb level was greater than 10 g per dL. Autologous blood transfusion was associated with a significantly lower rate ( 1 % ) of wound infections than allogeneic blood transfusion ( 4.2 % ) . CONCLUSION Accurate assessment of preoperative Hb levels , better estimation of perioperative blood loss , efficient use of autologous blood , adherence to transfusion guidelines , and pharmacologic alternatives contribute to effective and comprehensive blood and anemia management BACKGROUND Immunosuppression after major surgery increases the risk of infections . Natural killer cells play a pivotal part in defence against infection . We aim ed to investigate the immunomodulatory effects of different types of postoperative blood transfusion by use of a new assay for measuring the frequency of peripheral blood natural killer precursor cells ( NKpf assay ) . METHODS We measured the natural killer cell precursor ( NKp ) frequency before and 5 days after surgery in 120 patients undergoing joint replacement surgery . The patients were assigned to one of five groups according to the type of transfusion received : non-transfused ( n=32 ) , allogeneic non-leukodepleted blood ( eight ) , allogeneic leukodepleted blood ( 30 ) , autologous predeposited blood ( ten ) , and autologous salvaged blood collected within the first 24 h after surgery ( 40 ) . We also measured interferon gamma and interleukin 10 concentrations before and after surgery . FINDINGS The mean postoperative NKp frequency for all patients was lower than the preoperative values , except in patients receiving autologous salvaged blood , which was higher than all other groups ( p<0.0001 ) . Postoperative NKp frequencies for patients receiving allogeneic or autologous predeposited blood responded similarly ( p=0.99 ) , but these patients had lower NKp frequencies than did the non-transfused group ( p<0.0001 ) . Postoperative interferon gamma concentrations were higher in the autologous salvaged blood group ( p<0.0001 ) than in other groups , which did not differ from each other . Interleukin 10 concentrations were similar across all groups ( p=0.49 ) . INTERPRETATION Immunosuppression associated with surgery and blood loss was reflected in a reduced frequency of NKp and decreased interferon gamma . This immunosuppression was reversed by transfusion of autologous salvaged blood , suggesting that this fluid contained immunostimulants To determine the safety , efficacy and user-friendliness of two different postoperative autologous blood re-infusion systems , an open , r and omized , controlled study was performed . Eligible consecutive primary and revision total hip and knee replacement patients were r and omized for one of the two systems or for a control group in which shed blood was not re-infused . The nursing staff scored user-friendliness . Patients were monitored after re-infusion . In all three patient groups , a restrictive transfusion trigger was used . Sixty-nine of 70 r and omized patients were evaluated . Ease of use , efficacy and safety of both re-infusion systems were comparable . There was no difference in allogeneic blood use between the groups . Thirty per cent of the patients re-infused with autologous blood developed a mainly mild , febrile transfusion reaction . No other adverse reactions were seen . Signs of coagulopathy after re-infusion were not found . In multivariate analysis , autologous re-infusion was an independent factor associated with a shorter hospital stay . Both postoperative autologous blood re-infusion systems were of equal efficacy and safety . The contribution of autologous wound blood re-infusion to reduce allogeneic transfusions must be investigated in a larger study The purpose of our study was to determine the effectiveness of a postoperative autologous blood reinfusion system as an alternative to homologous , banked blood transfusions in total knee arthroplasty . We carried out a prospect i ve r and omised controlled study on 60 patients having unilateral total knee replacements . In all these patients , the same surgical team applied the same surgical technique , and all patients followed the same rehabilitation program . In 30 of these patients ( group A ) , a reinfusion system of unwashed salvaged blood was applied , and they were supplemented postoperatively with banked blood transfusions when required . A control group of 30 patients ( group B ) , in whom st and ard suction drains were used , received one unit of homologous banked blood transfusion intraoperatively and additional blood transfusions postoperatively when required . The administration of banked blood transfusion was determined by the haemoglobin value ( < 9 mg/dl ) and /or clinical signs ( blood pressure , pulse , etc . ) . The values of haemoglobin , haematocrit and platelets were recorded preoperatively and the first , fifth and 15th postoperative days , respectively . Five patients of group A required nine units of homologous blood ( 0.3 units/patient ) postoperatively . Ten patients of group B required an additional 15 banked blood units postoperatively ( in total 45 banked blood units for group B ; 1.5 units/patient ) . In the study group , the total homologous blood requirements were reduced by 80 % , while the postoperative blood requirements were reduced by 50 % . There was no significant difference in the postoperative haematocrit and haemoglobin values between the two groups . The cost of the blood management in the study group was reduced by 36 % . The use of an autologous blood reinfusion system  reduces highly effectively the dem and s of homologous banked blood transfusion in total knee arthroplasty . RésuméLe but de cette étude était de déterminer l’efficacité d’un système de réinjection post-opératoire de sang autologue comme alternative à la transfusion homologue dans l’arthroplastie totale de genou . Nous avons fait une étude prospect i ve r and omisée sur 60 patients opérés d’une prothèse totale du genou unilatérale . Chez 30 patients ( groupe A ) un système de réinjection sans lavage du sang préservé était utilisé avec supplémentation post-opératoire par du sang de banque si nécessaire . Un groupe de contrôle de 30 patients ( groupe B ) , chez qui un drainage aspiratif classique était utilisé , recevait une unité de sang homologue pendant l’intervention et des transfusions post-opératoires si nécessaire . L’indication de transfusion homologue était posé sur un taux d’hémoglobine < 9mg/dL et/ou des signes cliniques . Les valeurs de l’hémoglobine , de l’hématocrite et des plaquettes étaient relevées avant l’intervention et les premier , cinquième et quinzième jours post-opératoires . 5 patients du groupe A eurent besoin après l’opération de 9 unités de sang homologue ( 0,3 unité par patient ) . 10 patients du groupe B eurent besoin de 15 unités supplémentaires de sang homologue après l’opération ( au total 45 unités de sang homologue pour le groupe B ; 1,5 unités par patient ) . Dans le groupe étudié la nécessité globale de sang homologue était réduite de 80 % et la nécessité de transfusion post-opératoire de 50 % . Le coût de la gestion du sang était réduite de 36 % dans le groupe étudié . l’utilisation d’un système de réinjection du sang autologue réduit significativement la nécessité de  transfusion homologue dans l’arthroplastie totale du genou Introduction In patients undergoing total knee replacement ( TKR ) , most of the measured blood loss occurs during the postoperative period , and 30–50 % of these patients receive allogeneic blood transfusion ( ABT ) . For this reason , the salvage and return of unwashed filtered shed blood ( USB ) from postoperative drainage may represent an alternative to ABT in these patients . We have , therefore , evaluated the clinical utility of USB return in TKR patients , with a special focus on patients with mild anaemia . Material s and methods Data from 200 TKR patients ( group 2 ) receiving USB within the first 6 postoperative hours ( ConstaVac CBC II , Sryker ) were prospect ively collected . A retrospective series of 100 TRK patients served as the control group ( group 1 ) . Results USB return was possible in 162 patients who received a mean of 0.98±0.4 U/pte , without any clinical ly relevant incident . Return of USB decreased both the percentage of patients with ABT ( 48 % vs 11 % , for groups 1 and 2 , respectively ; p<0.01 ) and the ABT units/patient index ( 1.31±1.27 vs 0.29±0.87 units/patient , respectively ; p<0.01 ) . A transfusion protocol was not established , but there was no difference between groups with respect to either perioperative Hb levels or overall transfusion index , indicating that the transfusion criteria were uniform . However , for the subgroups of patients who needed ABT , the preoperative Hb level was 1 g/dL lower in those receiving USB ( 13.4±1.4 vs 12.4±1.2 g/dL ; p<0.05 ) . There was no difference in the postoperative complication rate , and patients in group 2 recovered the ability to walk 1 day earlier , and their hospital stay was 3 days shorter than in group 1 ( p<0.01 ) . Conclusions Return of USB after TKR seems to shorten the hospital stay and effectively reduce postoperative requirements for ABT , especially in patients with preoperative Hb > 13 g/dL. For patients with preoperative Hb < 13 g/dL , although the return of USB also decreased the requirements for ABT , a further reduction will probably be obtained with the addition of another blood-saving method Introduction Joint replacement is associated with massive blood loss . Various techniques have been used to avoid the use of allogeneic blood . One of the techniques used is postoperative salvage and reinfusion of shed blood that was found to reduce the use of banked blood with its potential risk . Material s and methods We prospect ively studied 365 patients who underwent knee joint replacement ( TKR )  and were divided in two groups . Group A ’s shed blood ( SureTrans System ) was collected ( n=194 ) and reinfused and group B ’s was not ( n=171 , “ controls ” ) . Hemoglobin levels before and after the operation were recorded . Results Allogeneic blood requirement for TKR decreased by 65 % in group A compared to group B. The packed cell/patient index dropped from 0.91 to 0.29 in group 2A . Statistical analysis yielded the odds ratio for blood replacement , a “ predicting formula ” for blood replacement depending on hemoglobin levels , and a cutoff point for a patient ’s receiving blood replacement . Conclusion We recommend using this system in TKR for decreasing allogeneic blood replacement and potential associated risks . The predicting formula for blood replacement may be a helpful tool when making a decision of whether or not to use the collector system and for whom BACKGROUND A before and after study was undertaken to investigate the effect of universal leukoreduction ( ULR ) in the UK on postoperative length of hospital stay ( LOS ) and infections . STUDY DESIGN AND METHODS Consecutive patients undergoing elective coronary artery bypass grafting or total hip and /or knee replacement in 11 hospitals  received non-WBC-reduced RBCs before implementation of ULR ( T1 , n=997 ) or WBC-reduced RBCs after implementation of ULR ( T2 , n=1098 ) . RESULTS Patients in T1 and T2 were comparable except patients in T2 received on average more units of RBCs but had lower discharge Hct levels . Postoperative LOS ( T1 , 10 + /- 8.9 days ; T2 , 9.6 + /- 6.9 days ) and the proportion of patients with suspected and proven postoperative infections ( T1 , 21.0 % ; T2 , 20.0 % ) were unchanged before and after ULR ( LOS , hazard ratio 1.01 , 95 % CI 0.92 - 1.10 ; infections , OR 0.83 , 95 % CI 0.77 - 1.02 ) . Subgroup analysis showed no significant interaction between storage age or dose of blood on responsiveness of primary outcomes to ULR . Secondary outcomes were unchanged overall . Analysis by surgical procedure gave conflicting results with both increased mortality ( p=0.031 ) and an increased proportion of cardiac patients with proven infections ( p=0.004 ) , whereas the proportion of orthopedic patients with proven infections was reduced ( p=0.002 ) after ULR . CONCLUSION Implementation of ULR had no major impact on postoperative infection or LOS in patients undergoing elective surgical procedures who received transfusion(s ) . Smaller effects , either detrimental or beneficial of ULR , can not be excluded We prospect ively r and omised 104 consecutive patients undergoing primary cemented total knee arthroplasty into two groups of 52 patients each , with one group to receive a st and ard suction drain ( Redivac ) and the other , an autologous transfusion drain ( Bellovac ) . R and omisation was achieved using the software programme MINIM , which was set to r and omly allocate patients to either of the two groups based on their age , sex and body mass index ( BMI ) . All procedures were performed under pneumatic tourniquet . Drains were released in the recovery room 20 min after surgery and removed 24 h following surgery . Blood collected in the st and ard suction drain ( control group ) was discarded , while blood collected in the autologous transfusion drains ( study group ) was transfused unwashed back to the patient within 6 h of collection . Thirteen patients ( 25 % ) in the study group had two or more units of homologous blood transfused in addition to the blood collected postoperatively and re-transfused ( average : 438 ml ) . Twelve patients ( 23 % ) in the control group had two or more units of homologous blood transfused . No sepsis , transfusion reactions or coagulopathies were associated with the autologous blood transfused in the study group . The use of the autologous transfusion system ( Bellovac ) proved to be safe but failed to reduce the need for postoperative homologous blood transfusion following uncomplicated total knee arthroplasty . RésuméNous avons étudié , de façon prospect i ve r and omisée , 104 patients consécutifs ayant bénéficié d’une prothèse totale du genou cimentée . Chaque patient a reçu soit un drain aspiratif st and ard ( Redivac ) soit un drain permettant une retransfusion ( Bellovac ) . 52 patients ont été r and omisés dans chaque groupe à l’aide d’un programme software avec une excellente concomitance entre l’âge , le sexe et le BMI . Toutes les interventions ont été réalisées avec garrot . Les drains ont été mis en aspiration en salle de réveil , 20 minutes après la fin de l’acte chirurgical . Ces drains ont été ôtés 24 heures après la chirurgie . Le sang collecté dans le drain st and ard a été rejeté alors que le drain Bellovac a permis de récupérer le sang , le retransfuser sans lavage six heures après l’intervention . 39 patients ( 25 % ) dans le groupe st and ard ont eu deux , ou plus de deux , unités sanguines de transfusion en plus du sang récupéré dans le drain ( 438 ml en moyenne ) . 12 patients ( 23 % ) dans le groupe contrôle ont eu deux , ou plus de deux , transfusions . Il n’y a pas eu d’infection , de réaction sanguine après ré-infusion du sang du redon . L’utilisation d’un système de réutilisation du sang de type Bellovac n’entraîne pas de problèmes particuliers mais il ne permet pas de diminuer la nécessité de transfusions post-opératoires après une prothèse totale du genou st and ard sans complication Background : Oral iron therapy is often used after orthopaedic surgery to improve haemoglobin levels . The aim of the present trial was to determine if administration of oral iron  after orthopaedic surgery results in a better improvement of haemoglobin levels than a control treatment A controlled , r and omized , prospect i ve study was performed evaluating the need for perioperative blood salvage for primary total hip arthroplasty patients who had donated autologous blood before surgery . One hundred fifty-three patients able to donate at least 2 units of autologous blood were divided into four groups . In group 1 ( 35 patients ) , intraoperative and postoperative Cell-Saver ( Haemonetics , Braintree , MA ) was employed . In group 2 ( 40 patients ) , a postoperative Solcotrans ( Smith & Nephew Richards , Memphis , TN ) reinfusion protocol was followed . In group 3 ( 40 patients ) , a closed-suction Hemovac drain ( Zimmer , Warsaw , IN ) was placed . In group 4 , ( 38 patients ) , no drain was used . Decisions for transfusion were based on clinical and laboratory parameters and made in conjunction with medical consultation . All autologous blood was routinely reinfused . There was no statistically significant difference in transfusion requirements or wound complications among the four groups . Hemoglobin and hematocrit changes between groups also were not statistically significant , but a power test suggested insufficient patient numbers for absolute reliability of this observation . Only five patients ( 3.3 % ) in this study received homologous blood . Four of these patients were in the Solcotrans group and one was in the Cell-Saver group . Two reoperations were performed : one for hematoma ( Solcotrans group ) and one for a sewn-in drain . It is concluded that expensive perioperative blood salvage techniques are usually not needed in patients who have a primary total hip arthroplasty without cement and who have donated 2 units of blood before operation We prospect ively r and omized 415 total joint replacements for either a closed wound-drainage system or no postoperative drainage . Drainage was not used in 200 total joint replacements , of which 138 were total knee replacements and sixty-two , total hip replacements . Drainage was used in 215 total joint replacements , of which 137 were total knee replacements and seventy-eight , total hip replacements . All patients were evaluated for the presence of excessive postoperative drainage that necessitated cessation of the range-of-motion exercises , the amount of transfused blood ( homologous and autologous ) , and the preoperative and postoperative hemoglobin levels . The range of motion was assessed daily in the patients who had a total knee replacement . No statistical difference was found in the number of patients who had excessive postoperative drainage from a drained or non-drained wound . There was also no statistical difference with respect to the amount of transfused blood and the preoperative and postoperative hemoglobin levels . Furthermore , in the patients who had a total knee replacement , there were no statistical differences between drained and non-drained wounds with respect to the daily range of motion during the first seven days postoperatively . The mean amount of blood transfused was 157 milliliters in the total knee replacements with drains , 160 milliliters in the total knee replacements without drains , 188 milliliters in the total hip replacements with drains , and ninety-three milliliters in the total hip replacements without drains . ( ABSTRACT TRUNCATED AT 250 WORDS We undertook a prospect i ve , r and omised study in order to evaluate the efficacy of clamping the drains after intra-articular injection of saline with 1:500 000 adrenaline compared with post-operative blood salvage in reducing blood loss in 212 total knee arthroplasties . The mean post-operative drained blood volume after drain clamping was 352.1 ml compared to 662.3 ml after blood salvage ( p < 0.0001 ) . Allogenic blood transfusion was needed in one patient in the drain group and for three in the blood salvage group . Drain clamping with intra-articular injection of saline with adrenaline is more effective than post-operative autologous blood transfusion in reducing blood loss during total knee arthroplasty We determined interleukin-6 ( IL-6 ) concentrations in collected shed drainage blood intended for retransfusion in a prospect i ve study in 81 patients after total knee replacement . We found large increases in IL-6 levels , averaging 6.5 ( SD 3.9 ) ng/mL , in shed blood collected in the first 6 postoperative hours . 3 patients had febrile reactions after collected blood was retransfused . The IL-6 levels in the drainage blood of these patients were very high ( 9.6 - 13.4 ng/mL ) . In the blood collected after 6 hours , IL-6 concentrations increased to 47 ( SD 33 ) ng/mL ( p < 0.001 ) . These results suggest a relation between increased interleukin-6 concentrations in shed drainage blood and the occurrence of febrile reactions after retransfusion of such blood Aim The aim of this study was to evaluate the efficacy of two different autotransfusion methods in total knee replacement ( TKR ) performed without tourniquet , in comparison to allogeneic blood transfusion ( ABT ) only . Method In a comparative study , 248 patients with knee osteoarthritis were r and omized in three groups : in control Group 85 the patients underwent only ABT post-operatively , in Group 1 ( n:92 ) an intraoperative and postoperative autotransfusion were utilized , and in Group 2 ( n:71 ) only a postoperative autotransfusion was applied . Post-operative ABT was utilized according to predetermined criteria . Results Comparing Group 0 to Group 1 and 2 the difference in need for ABT post-operatively was statistically highly significant ( p < 0.001 ) even when the results were analyzed classifying the patients according to the preoperative Hb levels . The difference between Group 1 and 2 was not significant . Conclusion According to the results of this study , auto-transfusion reduces the need for ABT  in TKR performed without tourniquet BACKGROUND This study was design ed to obtain data on the incidence of postoperative infection in patients undergoing elective orthopedic surgery and receiving white blood cell (WBC)-filtered blood components prepared according to current st and ards . STUDY DESIGN AND METHODS A total of 308 consecutive orthopedic patients who opted for preoperative autologous blood donation ( PAD ) for primary unilateral hip and knee replacement surgery were enrolled in a prospect i ve observational study of the incidence of postoperative infection . Patients with contraindications for PAD or with any infectious disease were not included in the study . To identify probably confounding factors , differences between patient groups were analyzed first . Identified factors , which differed between groups , and variables describing blood supply were further tested in uni- and multivariate logistic regression analysis for their independent influence on development of postoperative infection . Infection rates were compared on the basis of actual transfusion groups . RESULTS Of the 308 study patients , 101 were not transfused , 85 received their  PAD , 100 received allogeneic WBC-filtered red blood cells ( RBCs ) , and 22 were given autologous RBCs and additionally allogeneic WBC-filtered RBCs . Overall the infection rate was 6.82 percent ( 21/308 ) . Infection rates varied significantly between transfusion groups ( no transfusion , 6.9 % ; autologous RBCs , 1.2 % ; allogeneic WBC-filtered RBCs , 12.0 % ; both transfusion types , 4.6 % ; p = 0.03 ) . Allogeneic recipients showed significantly more infections compared to autologous recipients ( p = 0.0053 ) . Multivariate regression analysis confirmed transfusion of allogeneic WBC-filtered RBCs as an independent variable predicting postoperative infection ( odds ratio , 23.65 ; confidence interval , 1.3 - 422.1 ; p = 0.01 ) . CONCLUSION Differences in postoperative infection rates between allogeneic and autologous recipients are still observable , although universal WBC filtration has been introduced into clinical practice We have carried out a r and omised , controlled trial on 70 patients having unilateral total knee replacement in which  transfusion was either with homologous bank blood or by reinfusion of unwashed blood salvaged after operation .  No complications or adverse effects were observed from reinfusion . The need for bank blood was reduced by 86 % in the reinfusion group but , more importantly , the number of infective episodes was significantly less when the use of bank blood was avoided . The mean length of stay in hospital was also reduced by more than two days We undertook a prospect i ve r and omised controlled trial to investigate the efficacy of autologous retransfusion drains in reducing the need for allogenic blood requirement  after unilateral total knee replacement . We also monitored the incidence of post-operative complications . There were 86 patients in the control group , receiving st and ard care with a vacuum drain , and 92 who received an autologous drain and were retransfused postoperatively .  Following serial haemoglobin measurements at 24 , 48 and 72 hours , we found no difference in the need for allogenic blood between the two groups ( control group 15.1 % , retransfusion group 13 % ( p = 0.439 ) ) . The incidence of post-operative complications , such as wound infection , deep-vein thrombosis and chest infection , was also comparable between the groups . There were no adverse reactions associated with the retransfusion of autologous blood . Based on this study , the cost-effectiveness and continued use of autologous drains in total knee replacement should be question ed Purpose : To determine whether salvaged autologous blood collected postoperatively contains complement split products ( SC5b-9 ) , and pro-inflammatory cytokines ( IL-6 and IL-8 ) and whether there are any differences between blood collected during hip or knee surgery . Methods : Fifty-eight consecutive patients undergoing hip or knee replacement surgery were studied . Thirty-eight had postoperative bleeding large enough to require infusion of salvaged blood . The salvaged blood was filtered during collection through a 200 µm filter and before infusion a 40 µm filter was used . Sample s for complement and cytokine determinations were drawn from the circulation and from the collected blood . Results : High concentrations of SC5b-9 , IL-6 , and IL-8 were found in salvaged blood . The concentrations were higher than in the circulation ( P<0.05 ) . The circulating concentrations of IL-6 and IL-8 were increased 60 min and 12–18 hr after transfusion . There were no differences regarding SC5B-9 , IL-6 , and IL-8 in the blood collected after hip or knee surgery . Conclusion : Blood collected from a surgical wound contains large concentrations of inflammatory mediators . There were no differences between blood collected during hip or knee surgery . RésuméObjectif : Déterminer si la récupération postopératoire de sang autologue contient des produits de dégradation du complément ( SC 5b-9 ) et des cytokines pro-inflammatoires ( IL-6 et IL-8 ) , et s’il y a des différences avec le sang prélevé pendant l’opération de la hanche ou du genou . Méthode : L’étude a porté sur 58 patients successivement admis pour la mise en place d’une prothèse de hanche ou du genou . Chez 38 d’entre eux , les pertes sanguines postopératoires ont été assez importantes pour nécessiter la transfusion de sang récupéré . Ce sang a été filtré pendant le prélèvement avec un filtre de 200 µm et avant la transfusion avec un filtre de 40 µm . Des échantillons retenus de la circulation et du sang récupéré ont servi à déterminer la cytokine et le complément . Résultats : De fortes concentrations de SC5B-9 , IL-6 et IL-8 ont été trouvées dans le sang récupéré . Elles étaient plus élevées que celles de la circulation ( P<0,05 ) . Les concentrations circulantes de IL-6 et de IL-8 ont augmenté 60 min et 12–18 h après la transfusion . Aucune différence n’a été enregistrée concernant les SC5b-9 , IL-6 et IL-8 dans le sang prélevé après l’opération de hanche ou du genou . Conclusion : Le sang prélevé au site d’incision chirurgicale contient de gr and es concentrations de médiateurs de l’inflammation . Ce sang ne présente pas de différence avec celui qui est prélevé pendant une opération de hanche ou du genou We prospect ively r and omised 100 patients undergoing cemented total knee replacement to receive either a single deep closed-suction drain or no drain . The total blood loss was significantly greater in those with a drain ( 568 ml versus 119 ml , p < 0.01 ; 95 % CI 360 to 520 ) although those without lost more blood into the dressings ( 55 ml versus 119 ml , p < 0.01 ; 95 % CI -70 to 10 ) . There was no statistical difference in the postoperative swelling or pain score , or in the incidence of pyrexia , ecchymosis , time at which flexion was regained or the need for manipulation , or in the incidence of infection at a minimum of five years after surgery in the two groups . We have been unable to provide evidence to support the use of a closed-suction drain in cemented knee arthroplasty . It merely interferes with mobilisation and complicates nursing . Reinfusion drains may , however , prove to be beneficial BACKGROUND Allogeneic blood transfusions are associated with a number of well-recognized risks and complications . Postoperative retransfusion of filtered shed blood is an alternative to ( reduce ) allogeneic blood transfusion . The objectives of this study were to evaluate the clinical efficacy of retransfusion of filtered shed blood and to evaluate the complications , in particular febrile reactions . STUDY DESIGN AND METHODS In this clinical trial 160 patients undergoing primary total hip or knee replacement were r and omly assigned to receive either a retransfusion system ( Bellovac , AstraTech AB ) or a regular drain ( Abdovac , AstraTech AB ) . Patients with a preoperative hemoglobin ( Hb ) level of between 13.0 and 14.6 g per dL were included . The shed blood was returned 6 hours after operation . After surgery the anesthesiologist determined the transfusion trigger . When Hb level dropped below this trigger , an  allogeneic blood transfusion  was given . The following data were obtained : number of allogeneic blood transfusions , total volume of blood collected in the bag used for retransfusion , perioperative Hb levels , febrile reaction , and other complications . RESULTS In the control group 19 percent of the patients received at least one allogeneic blood transfusion . In the study group this percentage was 6 percent of the patients ( p = 0.015 ) . Comparing total knee and total hip arthroplasty ( control vs. study ) the percentages were , respectively , 16 percent versus 2 percent ( p = 0.040 ) and 21 percent versus 11 percent ( NS ) . On average 308 mL of filtered shed blood was retransfused in the study group . In the study group 18 percent of patients had febrile reactions compared to 20 percent in the control group . CONCLUSION Postoperative retransfusion of filtered shed blood is effective for decreasing allogeneic blood transfusions after total hip and knee arthroplasty . There was no relationship between retransfusions and postoperative febrile reactions BACKGROUND Total knee arthroplasty ( TKA ) or total hip arthroplasty ( THA ) regularly results in postoperative requirement of blood transfusion . Because of the disadvantages of allogeneic blood transfusion ( ABT ) such as the risk of transfusion-associated infections , incompatibility-related transfusion fatalities , or immunomodulatory effects , a continuing effort to reduce allogeneic blood transfusion is important . For this purpose , the effect of reinfusion of drain blood , via a postoperative wound drainage and reinfusion system , on the need for allogeneic blood transfusion was evaluated . STUDY DESIGN AND METHODS Using a prospect i ve observational quality assessment design , we compared 135 patients scheduled for TKA or THA with a historic group of 96 patients . In the study group the Bellovac ABT autotransfusion system was used . The shed blood was returned either when 500 mL were collected or at most 6 hours after surgery . Compared were the preoperative , postoperative , and discharge hemoglobin , as well as the number of allogeneic blood transfusions . RESULTS There were no statistical differences between preoperative , postoperative , and discharge hemoglobin levels . Autologous transfusion reduced the number of patients receiving ABT overall from 35 percent ( control ) to 22 percent ( study ) . The decrease of allogeneic transfusion requirement was most significant after TKA : from 18 percent to 6 percent ( p < 0.001 ) . CONCLUSION We conclude that the Bellovac ABT device reduces allogeneic blood transfusions in TKA and THA One hundred thirty-six primary total knee arthroplasty patients were r and omized for the use of closed-suction , nonreinfusable wound drains .  Blood loss was identical in the drained and undrained groups . Forty percent of undrained wounds compared with 0 % of drained wounds required dressing reinforcement . Sixty-nine percent of undrained wounds compared with 39 % of drained wounds developed ecchymosis , measuring 92 cm2 in the undrained group and 28 cm2 in the drained group . This study concludes that a simple wound drain effectively minimizes the undesirable accumulation of blood in the surrounding soft tissues and the postoperative wound dressing after total knee arthroplasty OBJECTIVES Definitive evidence that red blood cell transfusion improves outcome after vascular surgery is lacking . The aims of the study were to determine , among stable consecutive patients who underwent elective major vascular surgery  , ( 1 ) the association between postoperative transfusion and 30-day death , myocardial infa rct ion , and both , and ( 2 ) and if this association differs according to the presence of postoperative anaemia ( haemoglobin value less than 9.0 g/dL within 7 days after surgery ) . METHODS A retrospective observational study was conducted on 359 patients prospect ively screened according to the ACC/AHA guidelines for preoperative risk in non-cardiac surgery . Main outcome was 30-day death ; secondary outcomes 30-day myocardial infa rct ion , and composite of 30-day myocardial infa rct ion or death . RESULTS Of the patients included , 95 ( 26.5 % ) received at least one unit of red blood cells . Patients who received transfusion had a significantly increased hazard of 30-day death ( hazard ratio [ HR ] 11.72 , 95 % confidence interval [ CI ] 3.92 - 35.10 ; p<0.0001 ) , myocardial infa rct ion ( HR 3.3 , 95 % CI 1.7 - 6.1 ; p=0.0003 ) , and both ( HR 4.0 95 % CI 2.2 - 7.3 ; p<0.0001 ) . Such associations held even after adjusting for baseline characteristics , surgical risk , bleeding , and propensity to receive transfusion . There was a significant interaction between transfusion and postoperative anaemia ( p=0.012 ) . In patients without anaemia , transfusion was associated with higher risk of 30-day death ( HR 19.20 , 95 % CI 3.99 - 92.45 ; p=0.007 ) , myocardial infa rct ion ( HR 5.05 , 95 % CI 2.23 - 11.44 ; p=0.0001 ) , and both . Conversely , in patients with anaemia this association was not significant . CONCLUSIONS In patients who underwent elective major vascular surgery , perioperative transfusion was associated with a significantly increased risk of 30-day events which was more attributable to patients with lesser degree of anaemia . Our data caution against the use of liberal transfusion in stable vascular surgery patients
target: Findings and Conclusion To our knowledge , this is the first meta- analysis to compare the clinical results between PAT and a control in joint replacement patients .
  This meta- analysis has proven that the use of a PAT reinfusion system reduced significantly the dem and for ABT , the number of patients who require ABT and the cost of hospitalization after total knee and hip arthroplasty .
  This study , together with other previously published data , suggests that PAT drains are beneficial .
background: Background Total hip or knee arthroplasty is an elective procedure that is usually accompanied by substantial blood loss , which may lead to acute anemia .
  As a result , almost half of total joint arthroplasty patients receive allogeneic blood transfusions ( ABT ) .
  Many studies have shown that post-operative auto-transfusion ( PAT ) significantly reduces the need for  ABT  , but other studies have question ed the efficacy of this method .