Willburger R E, Rüberg K, Knorth H, Casagranda O, Laubenthal H, Wiese M
Orthopädische Universitätsklinik Bochum.
Z Orthop Ihre Grenzgeb. 2005 May-Jun;143(3):360-4. doi: 10.1055/s-2005-836454.
Preoperative autologous blood donation before joint replacement has become standard practice. However, this procedure is discussed controversially regarding medical benefit and cost-effectiveness.
In a retrospective study the data of 994 patients scheduled for hip (THR) or knee arthroplasty (TKR) between 1/2000 and 9/2002 were analysed.
Altogether 612 patients donated autologous blood (61.6 %). 50.2 % of the patients got blood transfusions during surgery or in the course of their hospitalisation. Donors received blood units more often than non-donors (55.2 vs. 41.9 %). On average 1.4 +/- 1.7 blood units were given during or after THR and 0.8 +/- 1.1 units during or after TKR. Clear predispositions for an increased use of blood transfusions were cemented endoprosthesis, old age (> 70 years) as well as exclusive general anaesthesia. Since 57.8 % of the blood units were wasted, the additional expenses (only laboratory and material costs were calculated) for each retransfused autologous blood unit were calculated to be 28.76.
Besides saving homologous blood, autologous blood donation causes mainly an increased probability of giving transfusions and higher costs. Therefore autologous blood donation should be indicated more critically, especially in younger patients and knee replacements.
关节置换术前进行自体血捐献已成为标准做法。然而，该程序在医学益处和成本效益方面存在争议。
在一项回顾性研究中，分析了2000年1月至2002年9月期间计划进行髋关节置换术（THR）或膝关节置换术（TKR）的994例患者的数据。
共有612例患者进行了自体血捐献（61.6%）。50.2%的患者在手术期间或住院期间接受了输血。捐献者比未捐献者更常接受输血单位（55.2%对41.9%）。THR期间或之后平均输注1.4±1.7个血单位，TKR期间或之后平均输注0.8±1.1个血单位。使用输血增加的明显倾向包括骨水泥型假体、老年（>70岁）以及单纯全身麻醉。由于57.8%的血单位被浪费，计算得出每重新输注一个自体血单位的额外费用（仅计算实验室和材料成本）为28.76。
除了节省异体血外，自体血捐献主要导致输血概率增加和成本升高。因此，应更严格地确定自体血捐献的指征，尤其是在年轻患者和膝关节置换术中。
