[Various problems of the methodology of autologous transfusion of photomodified blood].
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Efforts to avoid complications associated with transfusion of allogeneic blood have increased the use of preoperatively donated autologous blood (PAB). A major controversy has arisen: Should the same criteria be used for transfusion of autologous as allogeneic red cells? This study prospectively and randomly compared giving PAB immediately after total knee arthroplasty (TKA), beginning in the recovery room or delaying a transfusion until the patient's hemoglobin had fallen to less than a 9.0 g/dL transfusion trigger point. The results show that patients who received immediate transfusion had fewer nonsurgical complications (P < .002). Because TKAs are associated with an average blood loss of 1,400 mL, we recommend that PAB be used in the immediate postoperative period, especially in the elderly, in whom the risk for cardiac or nonsurgical complications is inherently increased.
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ABSTRACT Blood transfusion requirements were analyzed in 102 total knee arthroplasties in 92 patients. All components were cemented, and no postoperative drainage was used. Six patients received transfusions; two of these patients received transfusions for symptoms and four received transfusions prophylactically. These findings do not support the routine practice of preoperative autologous blood donation.
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We retrospectively studied autologous blood transfusion in 65 cases of hip and knee arthroplasty. The cases consisted of 10 males and 45 females whose age ranged from 34 to 81, with an average age of 61.3 years.Autologous blood was preserved by liquid, and in 35 cases, Erythropoietin (EPO) was intravenously administrated 3 times a week.We have been performing autologous blood transfusion on patients treated with hip and knee arthroplasty since 1990, and the method allows us to avoid homologous transfusion in 88.9% of our patients.
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Hip Arthroplasty
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From 1994 to 1998, we performed 170 bilateral total knee arthroplasties (TKAs) with cemented, posterior cruciate-substituting prostheses. Blood management included preoperative autologous donation, symptom-based transfusion, and autoreinfusion devices. Perioperative allogeneic transfusion rates for patients who donated 0, 1, 2, 3, or 4 units of blood were 40.00%, 0.00%, 3.70%, 0.00%, and 3.23%, respectively. Preoperative autologous donation >2 units also resulted in lower preoperative hemoglobin levels. For bilateral TKA, a protocol of 2 preoperative autologous donation units and reinfusion of postoperative drainage reduces anemia during the preoperative and postoperative periods.
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A prospective study was undertaken to assess the efficacy and financial cost of the use of an autologous blood transfusion device in the reduction of allogeneic blood requirements of patients undergoing primary unilateral total knee arthroplasty. Forty-nine consecutive patients received either the CellTrans blood salvage device (group A of 32 patients) or the Redivac high vacuum drainage system (group B of 17 patients). The preoperative and postoperative haemoglobin levels were recorded at 72 or 96 hours. Nine percent of group A patients received an allogeneic blood transfusion compared to 59% in group B. There was an average saving of 1.1 unit of allogeneic blood per patient in group A (p<0.001). The total cost per patient was about Euro 111 less for the group A patients. Autologous re-infusion was found in this study to be an effective method of reducing allogeneic blood requirements and to afford significant cost savings in primary unilateral knee arthroplasty.
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Total Knee Replacement
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A study was undertaken at St. Mary's Hospital to determine the number of reduction mammaplasty patients receiving blood transfusions during or after surgery. Only 3 of 192 patients in a 3-year period required blood. With the use of xylocaine 0.5% with 1:200,000 adrenalin injected into the breasts before surgery, bleeding was decreased. Thus, the only patient who received blood in the next 203 patients was one who had an autologous unit collected preoperatively and who did not really require it. None of the 11 patients with amounts of breast tissue removed weighing between 3,000 to 4,200 g required blood transfusions.
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Idiopathic scoliosis
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Rachis
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Idiopathic scoliosis
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We have performed 39 autologous blood transfusions in 26 rheumatoid arthritis patients who had a total knee arthroplasty (TKA). The patients were divided into 4 groups. Seven patients had the transfusion using the leap-frog method without erythropioetin (epo), 13 cases were simple predeposition without epo, 10 cases used the leap-frog method with epo, and 9 cases were simple predeposition with epo. Simple pre-deposition was used together with the postoperative autologous transfusion system. Epo was very effective in rheumatoid patients who had severe anemia, but autologous blood could be collected without epo in those who had a Hb of more than 11.5g/dl and if the postoperative autologous transfusion system was used, we could perform TKA at a predeposition of 600ml.
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