Suh You-Sung, Nho Jae-Hwi, Choi Hyung-Suk, Ha Yong-Chan, Park Jong-Seok, Koo Kyung-Hoi
Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401, South Korea.
Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 156-755, South Korea.
Arch Orthop Trauma Surg. 2016 Sep;136(9):1213-1226. doi: 10.1007/s00402-016-2516-7. Epub 2016 Jul 23.
Arthroplasties of hip and knee are associated with blood loss, which may lead to adverse patient outcome. Performing arthroplasties in Jehovah's Witness patients who do not accept transfusion has been a matter of concern. We developed a protocol, which avoids transfusion in arthroplasties of Jehovah's Witness patients, and evaluated the feasibility and safety of the protocol.
The target of preoperative hemoglobin was more than 10 g/dL. When preoperative hemoglobin was lower than 10 g/dL, 4000 U erythropoietin (3 times a week) and 100 mg iron supplement (every day) were administered until the hemoglobin reached 10 g/dL. When the preoperative hemoglobin was higher than 10 g/dL, 4000 U erythropoietin and 100 mg iron supplement were administered once, before operation. During the operation, cell saver was used. Postoperatively, erythropoietin and iron supplements were administered until the hemoglobin reached 10 g/dL, similar to the preoperative protocol. We evaluated the feasibility of our protocol, perioperative complications and hematologic changes.
From 2002 to 2014, 186 Witness patients visited our department. In 179 patients (96.2 %), 77 total knee arthroplasties, 69 bipolar hemiarthroplasties and 33 total hip arthroplasties were performed. The mean hemoglobin level was 12.3 g/dL preoperatively, 9.4 g/dL on postoperative day 3 and 10.3 g/dL on postoperative day 7. One patient died immediately after the arthroplasty and the remaining 178 patients survived.
Total joint arthroplasty could be done without transfusion using this protocol in most of our patients. The rates of infection and mortality were similar with known infection and mortality rates of arthroplasties. In patients who do not want allogeneic transfusions, our protocol is a safe alternative to perform joint arthroplasties.
髋关节和膝关节置换术会导致失血，这可能会给患者带来不良后果。在不接受输血的耶和华见证会患者中进行关节置换术一直是一个令人担忧的问题。我们制定了一项方案，该方案可避免在耶和华见证会患者的关节置换术中进行输血，并评估了该方案的可行性和安全性。
术前血红蛋白目标值超过10g/dL。当术前血红蛋白低于10g/dL时，给予4000U促红细胞生成素（每周3次）和100mg铁补充剂（每天），直至血红蛋白达到10g/dL。当术前血红蛋白高于10g/dL时，在手术前给予一次4000U促红细胞生成素和100mg铁补充剂。手术期间，使用血液回收机。术后，给予促红细胞生成素和铁补充剂，直至血红蛋白达到10g/dL，与术前方案类似。我们评估了该方案的可行性、围手术期并发症和血液学变化。
2002年至2014年，186名见证会患者前来我院就诊。其中179例（96.2%）患者接受了77例全膝关节置换术、69例双极半髋关节置换术和33例全髋关节置换术。术前平均血红蛋白水平为12.3g/dL，术后第3天为9.4g/dL，术后第7天为10.3g/dL。1例患者在关节置换术后立即死亡，其余178例患者存活。
在我们的大多数患者中，使用该方案可以在不输血的情况下进行全关节置换术。感染率和死亡率与已知的关节置换术感染率和死亡率相似。对于不希望接受异体输血的患者，我们的方案是进行关节置换术的一种安全选择。
