Department of anesthesiology and pain medicine, National Health Insurance Service, Ilsan Hospital, 100, Ilsan-ro, Ilsandong-gu, Goyang-si, 10444 Gyeonggi-do, Republic of Korea.
Department of anesthesiology and pain medicine, National Health Insurance Service, Ilsan Hospital, 100, Ilsan-ro, Ilsandong-gu, Goyang-si, 10444 Gyeonggi-do, Republic of Korea.
Transfus Clin Biol. 2021 Feb;28(1):73-79. doi: 10.1016/j.tracli.2020.10.003. Epub 2020 Oct 16.
After total knee arthroplasty (TKA), many patients experience anemia due to blood loss. To prevent postoperative anemia and allogeneic blood transfusion after TKA, we used prophylactic allogeneic or autologous blood transfusion intraoperatively. This study evaluated the effects of prophylactic transfusion during TKA.
This retrospective cohort study included 579 patients receiving scheduled unilateral TKA. We allocated the patients into three groups, the prophylactic allogeneic transfusion (Group AL), prophylactic autologous transfusion (Group AT), and no prophylactic transfusion with intra-articular tranexamic acid administration (GroupC) groups. After propensity score matching, we compared the rate of postoperative allogeneic blood transfusions until three days after TKA, postoperative hemoglobin and hematocrit levels until four days after TKA, and the side effects in each groups.
The postoperative allogeneic blood transfusion rates were statistically higher in group AL and AT than in group C (18.2% and, 18.9% vs 2.3%, respectively; P<0.000). The postoperative hemoglobin and hematocrit levels were statistically lower in group Auto than in group C (P<0.0001), but the levels in group AL were not different from those of group C (P=0.493 vs. P=0.384 respectively). In addition, the side effects were statistically higher in group AL and AT than in group C.
Prophylactic intra-operative transfusions did not reduce the rates of allogeneic transfusions and produced more side effects and hypotension after surgery than intra-articular tranexamic acid administration with no prophylactic transfusion in patients undergoing TKAs.
全膝关节置换术（TKA）后，许多患者因失血而出现贫血。为预防 TKA 后术后贫血和异体输血，我们术中预防性使用同种异体或自体输血。本研究评估了 TKA 术中预防性输血的效果。
这是一项回顾性队列研究，纳入了 579 例行单侧 TKA 的患者。我们将患者分为三组：预防性同种异体输血组（Group AL）、预防性自体输血组（Group AT）和无预防性输血并给予关节内氨甲环酸组（Group C）。在进行倾向评分匹配后，我们比较了三组患者术后至 TKA 后 3 天的异体输血率、术后至 TKA 后 4 天的血红蛋白和血细胞比容水平，以及各组的不良反应。
Group AL 和 AT 的术后异体输血率明显高于 Group C（分别为 18.2%和 18.9% vs. 2.3%；P<0.000）。与 Group C 相比，Group Auto 的术后血红蛋白和血细胞比容水平明显较低（P<0.0001），但 Group AL 的水平与 Group C 无差异（P=0.493 对 P=0.384）。此外，Group AL 和 AT 的不良反应发生率明显高于 Group C。
与关节内给予氨甲环酸而不进行预防性输血相比，TKA 术中预防性输血并不能降低异体输血率，反而会增加术后不良反应和低血压的发生。
