Article OriginalEffets de l'autotransfusion postopératoire au cours de la chirurgie prothétique de hanche avec le dispositif ConstaVac™Effects of postoperative autotransfusion after total hip replacement using the ConstaVac™ device*

A new device for postoperative autotransfusion ConstaVac™, Stryker) was assessed after total hip replacement in 43 patients, mean age 63 ± 13 years. Intraoperative blood was administered to 27 patients (63 %), autologous blood only in 19, homologous blood only in 6 and both autologous and homologous blood in 2. The blood shed during an average 5-hour postoperative period had an haematocrit of 23 ± 7 % and included only few platelets (72 ± 83 G · l−1). It did not clot as it contained there was less than 0.1 g · l−1 of fibrinogen and a high concentration of D-dimers. In 30 patients (70 %), the amount of blood thus collected exceeded 200 ml. An average of 327 ± 131 ml were subsequently retransfused to these patients. Postoperative autotransfusion induced a moderate but significant decrease in platelet counts (205 ± 66 vs. 224 ± 67 G · l−1, p < 0.02) and fibrinogen concentrations (2.3 ± 0.7 vs. 2.4 ± 0.6 g · l−1, p < 0.03), and an increase in circulating D-dimers (p < 0.001). Coagulation tests, free plasma haemoglobin and potassium concentrations were not significantly altered. Since the haematocrit of the blood lost was lower than that of the patients', the haematocrit did not increase significantly. Posttransfusion shivering occurred in two patients (7 %). Bacteriological cultures of the lost blood and of venous samples obtained after postoperative autotransfusion remained sterile. Postoperative autotransfusion is a simple technique with few side-effects, which might be safely associated with other methods used to decrease the rate of homologous blood transfusion.