Minoda Yukihide, Sakawa Akira, Fukuoka Shinichi, Tada Koichi, Takaoka Kunio
Department of Orthopaedic Surgery, Osaka City University Medical School, 1-4-3 Asahimachi, Abeno-ku, 545-8585 Osaka, Japan.
Arch Orthop Trauma Surg. 2004 Jun;124(5):317-9. doi: 10.1007/s00402-004-0647-8. Epub 2004 Apr 2.
The risk of requiring allogeneic blood transfusion after total knee arthroplasty has been recently decreased with several methods such as blood donation, blood salvage, and hematinic. For patients with a low baseline hemoglobin level, however, the rate of allogeneic transfusion is still high, and an effective method for avoiding allogeneic blood transfusion has not been established. We introduced intra- and postoperative blood salvage with the Cell Saver for patients with a baseline hemoglobin level lower than 130 g/l and analyzed the frequency of allogeneic blood transfusion.
From 1993 to 1997, 218 consecutive total knee arthroplasties were performed, and 155 knees with baseline hemoglobin lower than 130 g/l were included in this study. Baseline hemoglobin ranged from 62 to 129 g/l, with a mean of 110 g/l. All patients were managed with intra- and postoperative blood salvage with the Cell Saver. Preoperative autologous blood donation and/or use of hematinic was performed for 129 knees (group 1) and was not performed for 26 knees (group 2). There were no significant differences between the two groups with regard to preoperative factors. To examine the role of perioperative factors (age, sex, baseline hemoglobin level, revision procedure, preoperative blood donation, and use of hematinic) in determining the requirements for allogeneic transfusion, backward elimination logistic regression analysis was used.
Seven knees (4.5%) required allogeneic transfusion. Group 1 (2.3%) exhibited a lower rate of allogeneic blood transfusion than group 2 (15.4%) (p=0.016). Hemoglobin levels on the day (p=0.016), 1 week (p=0.0001), and 2 weeks (p=0.007) after surgery were lower in group 1 than in group 2. Backward elimination logistic regression analysis showed that preoperative blood donation (p=0.048) and use of hematinic (p=0.040) were significantly associated with a requirement for allogeneic blood transfusion.
Preoperative blood donation and use of hematinic were associated with a low incidence of allogeneic blood transfusion after total knee arthloplasty with intra- and postoperative blood salvage, even for patients with a baseline hemoglobin level below 130 g/l.
全膝关节置换术后同种异体输血的风险近来已通过多种方法有所降低，如自体献血、血液回收及补血药的使用。然而，对于基线血红蛋白水平较低的患者，同种异体输血率仍然很高，且尚未确立一种有效的避免同种异体输血的方法。我们对基线血红蛋白水平低于130g/l的患者采用血液回收机进行术中及术后血液回收，并分析同种异体输血的频率。
1993年至1997年，连续进行了218例全膝关节置换术，本研究纳入了155例基线血红蛋白低于130g/l的膝关节。基线血红蛋白范围为62至129g/l，平均为110g/l。所有患者均采用血液回收机进行术中及术后血液回收。129例膝关节（第1组）进行了术前自体献血和/或使用补血药，26例膝关节（第2组）未进行。两组术前因素无显著差异。为研究围手术期因素（年龄、性别、基线血红蛋白水平、翻修手术、术前献血及补血药的使用）在决定同种异体输血需求方面的作用，采用向后逐步回归逻辑回归分析。
7例膝关节（4.5%）需要同种异体输血。第1组（2.3%）的同种异体输血率低于第2组（15.
