[Effectiveness of autologous blood replacement in rheumatoid arthritis surgery--a report of 10 years experience].

The management and the resulting effectiveness of a four-step autotransfusion concept, consisting of preoperative autologous blood predeposit, isovolaemic haemodilution, preoperative plasmapheresis and intraoperative autotransfusion in rheumatic patients undergoing planned operations associated with considerable blood loss, are presented. In just one case out of 117 primary total joint replacements of the hip or knee that were retrospectively studied in rheumatic patients suffering from chronic anaemia did a homologous erythrocyte concentrate have to be transfused. A 19-year-old patient suffering from juvenile arthritis who underwent a total knee replacement operation had the lowest haemoglobin and haematocrit levels with a perioperative haemoglobin of 4.2 g/dl and a haematocrit of 12.4%. In 1996, 4,073 autologous transfusions were made by the anaesthetic ward. The autotransfusion concept was established in 1988. At that time 47% of the total blood demand was replaced by autologous transfusion. In 1989 there was an increase to 88%, in 1990 to 94%, and in 1991 to 98%. From 1992 up to 1996 the autologous transfusions covered continuously more than 99% of the total blood demand. It is pointed out, that under normovolaemic conditions the chronic anaemia of these rheumatic patients is a contraindication neither for predeposit nor for intraoperative autotransfusion.