PERIOPERATIVE BLOOD MANAGEMENT STRATEGIES FOR JOINT ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LILintao ,  WUHaishan , WUYuli , FUPeiliang , DINGZheru

Department of Joint Surgery, Shanghai Changzheng Hospital, Shanghai, 200003, P. R. China;

Corresponding author：

WUHaishan, Email: drisland@vip.sina.com

Keywords：

Arthroplasty; Perioperative period; Blood loss; Blood transfusion

DOI：

10.7507/1002-1892.20150165

Video：

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Objective To summarize the perioperative blood management strategies for joint arthroplasty. Methods The literature concerning preoperative, intraoperative, and postoperative blood management was reviewed and summarized. Results At present, a variety of blood management and conservation strategies are available. Preoperative strategies include iron supplementation, erythropoietin (EPO), and preoperative autologous donation (PAD). Intraoperative options include acute normovolemic hemodilution (ANH), antifibrinolytics, and the use of a tourniquet. Postoperative strategies include the use of reinfusion systems and guided transfusion protocols. Preoperatively, administration of either simple EPO or a combination of EPO and PAD can be efficacious in anemic patients. Intraoperatively, tourniquet use and tranexamic acid can effectively control bleeding. Postoperatively, appropriate transfusion indications can avoid unnecessary blood transfusions. Conclusion Perioperative blood management strategies for joint arthroplasty should be integrated for the individual patient using a variety of ways to reduce perioperative blood loss and blood transfusion, and promote the rehabilitation of patients.

Citation： LILintao, WUHaishan, WUYuli, FUPeiliang, DINGZheru. PERIOPERATIVE BLOOD MANAGEMENT STRATEGIES FOR JOINT ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(6): 772-776. doi: 10.7507/1002-1892.20150165 Copy

1.	Rosencher N, Kerkkamp HE, Macheras G, et al. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study:blood management in elective knee and hip arthroplasty in Europe. Transfusion, 2003, 43(4):459-469.
2.	Stulberg BN, Zadzilka JD. Blood management issues using blood management strategies. J Arthroplasty, 2007, 22(4 Suppl 1):95-98.
3.	Hart A, Khalil JA, Carli A, et al. Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates. J Bone Joint Surg (Am), 2014, 96(23):1945-1951.
4.	Spahn DR. Anemia and patient blood management in hip and knee surgery:a systematic review of the literature. Anesthesiology, 2010, 113(2):482-495.
5.	Carson JL, Noveck H, Berlin JA, et al. Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion, 2002, 42(7):812-818.
6.	Kapadia BH, Banerjee S, Issa K, et al. Preoperative blood management strategies for total knee arthroplasty. J Knee Surg, 2013, 26(6):373-377.
7.	Andrews CM, Lane DW, Bradley JG. Iron pre-load for major joint replacement. Transfus Med, 1997, 7(4):281-286.
8.	Lachance K, Savoie M, Bernard M, et al. Oral ferrous sulfate does not increase preoperative hemoglobin in patients scheduled for hip or knee arthroplasty. Ann Pharmacother, 2011, 45(6):764-770.
9.	Jelkmann W. Erythropoietin:structure, control of production, and function. Physiol Rev, 1992, 72(2):449-489.
10.	So-Osman C, Nelissen RG, Koopman-van Gemert AW, et al. Patient blood management in elective total hip- and knee-replacement surgery (Part 1):a randomized controlled trial on erythropoietin and blood salvage as transfusion alternatives using a restrictive transfusion policy in erythropoietin-eligible patients. Anesthesiology, 2014, 120(4):839-851.
11.	Laffosse JM, Minville V, Chiron P, et al. Preoperative use of epoietin beta in total hip replacement:a prospective study. Arch Orthop Trauma Surg, 2010, 130(1):41-45.
12.	Tomeczkowski J, Stern S, Müller A, et al. Potential cost saving of Epoetin alfa in elective hip or knee surgery due to reduction in blood transfusions and their side effects:a discrete-event simulation model. PLoS One, 2013, 8(9):e72949.
13.	Deutsch A, Spaulding J, Marcus RE. Preoperative epoetin alfa vs autologous blood donation in primary total knee arthroplasty. J Arthroplasty, 2006, 21(5):628-635.
14.	Keating EM, Callaghan JJ, Ranawat AS, et al. A randomized, parallel-group, open-label trial of recombinant human erythropoietin vs preoperative autologous donation in primary total joint arthroplasty:effect on postoperative vigor and handgrip strength. J Arthroplasty, 2007, 22(3):325-333.
15.	Keating EM, Ritter MA. Transfusion options in total joint arthroplasty. J Arthroplasty, 2002, 17(4 Suppl 1):125-128.
16.	Nelson CL, Fontenot HJ, Flahiff C, et al. An algorithm to optimize perioperative blood management in surgery. Clin Orthop Relat Res, 1998, (357):36-42.
17.	国家卫生和计划生育委员会. 临床输血技术规范. 柳州医学, 2012, 25(1):75-77.
18.	Zohar E, Fredman B, Ellis M, et al. A comparative study of the postoperative allogeneic blood-sparing effect of tranexamic acid versus acute normovolemic hemodilution after total knee replacement. Anesth Analg, 1999, 89(6):1382-1387.
19.	Messmer K. Hemodilution-possibilities and safety aspects. Acta Anaesthesiol Scand Suppl, 1988, 89:49-53.
20.	Martin E, Hansen E, Peter K. Acute limited normovolemic hemodilution:a method for avoiding homologous transfusion. World J Surg, 1987, 11(1):53-59.
21.	Oishi CS, D'Lima DD, Morris BA, et al. Hemodilution with other blood reinfusion techniques in total hip arthroplasty. Clin Orthop Relat Res, 1997, (339):132-139.
22.	Segal JB, Blasco-Colmenares E, Norris EJ, et al. Preoperative acute normovolemic hemodilution:a meta-analysis. Transfusion, 2004, 44(5):632-644.
23.	Goodnough LT, Monk TG, Despotis GJ, et al. A randomized trial of acute normovolemic hemodilution compared to preoperative autologous blood donation in total knee arthroplasty. Vox Sang, 1999, 77(1):11-16.
24.	Sabatini L, Atzori F, Revello S, et al. Intravenous use of tranexamic acid reduces postoperative blood loss in total knee arthroplasty. Arch Orthop Trauma Surg, 2014, 134(11):1609-1614.
25.	Alshryda S, Sukeik M, Sarda P, et al. A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. Bone Joint J, 2014, 96-B(8):1005-1015.
26.	Fiechtner BK, Nuttall GA, Johnson ME, et al. Plasma tranexamic acid concentrations during cardiopulmonary bypass. Anesth Analg, 2001, 92(5):1131-1136.
27.	Panteli M, Papakostidis C, Dahabreh Z, et al. Topical tranexamic acid in total knee replacement:a systematic review and meta-analysis. Knee, 2013, 20(5):300-309.
28.	Camarasa MA, Ollé G, Serra-Prat M, et al. Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement:a randomized clinical trial. Br J Anaesth, 2006, 96(5):576-582.
29.	Whitehead DJ, MacDonald SJ. TKA sans tourniquet:let it bleed:opposes. Orthopedics, 2011, 34(9):e497-499.
30.	Tai TW, Chang CW, Lai KA, et al. Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty:a randomized controlled trial. J Bone Joint Surg (Am), 2012, 94(24):2209-2215.
31.	Alcelik I, Pollock RD, Sukeik M, et al. A comparison of outcomes with and without a tourniquet in total knee arthroplasty:a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty, 2012, 27(3):331-340.
32.	Harvey EJ, Leclerc J, Brooks CE, et al. Effect of tourniquet use on blood loss and incidence of deep vein thrombosis in total knee arthroplasty. J Arthroplasty, 1997, 12(3):291-296.
33.	Tai TW, Lin CJ, Jou IM, et al. Tourniquet use in total knee arthroplasty:a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2011, 19(7):1121-1130.
34.	Zan PF, Yang Y, Fu D, et al. Releasing of tourniquet before wound closure or not in total knee arthroplasty:a meta-analysis of randomized controlled trials. J Arthroplasty, 2015, 30(1):31-37.
35.	Kubota R, Nozawa M, Matsuda K, et al. Combined preoperative autologous blood donation and intra-operative cell salvage for hip surgery. J Orthop Surg (Hong Kong), 2009, 17(3):288-290.
36.	Moonen AF, Knoors NT, van Os JJ, et al. Retransfusion of filtered shed blood in primary total hip and knee arthroplasty:a prospective randomized clinical trial. Transfusion, 2007, 47(3):379-384.
37.	Martin A, von Strempel A. Transfusion of autologous blood from reinfusion systems in total knee arthroplasty. Int Orthop, 2006, 30(6):541-544.
38.	Singh VK, Singh PK, Javed S, et al. Autologous transfusion of drain contents in elective primary knee arthroplasty:its value and relevance. Blood Transfus, 2011, 9(3):281-285.
39.	Sarkanović ML, Gvozdenović L, Savić D, et al. Autologous blood transfusion in total knee replacement surgery. Vojnosanit Pregl, 2013, 70(3):274-278.
40.	Matsuda K, Nozawa M, Katsube S, et al. Activation of fibrinolysis by reinfusion of unwashed salvaged blood after total knee arthroplasty. Transfus Apher Sci, 2010, 42(1):33-37.
41.	Al-Zahid S, Davies AP. Closed suction drains, reinfusion drains or no drains in primary total knee replacement? Ann R Coll Surg Engl, 2012, 94(5):347-350.
42.	Napolitano LM, Kurek S, Luchette FA, et al. Clinical practice guideline:red blood cell transfusion in adult trauma and critical care. J Trauma, 2009, 67(6):1439-1442.
43.	Robinson PM, Obi N, Harrison T, et al. Changing transfusion practice in total hip arthroplasty:observational study of the reduction of blood use over 6 years. Orthopedics, 2012, 35(11):e1586-1591.
44.	Goodnough LT, Maggio P, Hadhazy E, et al. Restrictive blood transfusion practices are associated with improved patient outcomes. Transfusion, 2014, 54(10 Pt 2):2753-2759.

1. Rosencher N, Kerkkamp HE, Macheras G, et al. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study:blood management in elective knee and hip arthroplasty in Europe. Transfusion, 2003, 43(4):459-469.
2. Stulberg BN, Zadzilka JD. Blood management issues using blood management strategies. J Arthroplasty, 2007, 22(4 Suppl 1):95-98.
3. Hart A, Khalil JA, Carli A, et al. Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates. J Bone Joint Surg (Am), 2014, 96(23):1945-1951.
4. Spahn DR. Anemia and patient blood management in hip and knee surgery:a systematic review of the literature. Anesthesiology, 2010, 113(2):482-495.
5. Carson JL, Noveck H, Berlin JA, et al. Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion, 2002, 42(7):812-818.
6. Kapadia BH, Banerjee S, Issa K, et al. Preoperative blood management strategies for total knee arthroplasty. J Knee Surg, 2013, 26(6):373-377.
7. Andrews CM, Lane DW, Bradley JG. Iron pre-load for major joint replacement. Transfus Med, 1997, 7(4):281-286.
8. Lachance K, Savoie M, Bernard M, et al. Oral ferrous sulfate does not increase preoperative hemoglobin in patients scheduled for hip or knee arthroplasty. Ann Pharmacother, 2011, 45(6):764-770.
9. Jelkmann W. Erythropoietin:structure, control of production, and function. Physiol Rev, 1992, 72(2):449-489.
10. So-Osman C, Nelissen RG, Koopman-van Gemert AW, et al. Patient blood management in elective total hip- and knee-replacement surgery (Part 1):a randomized controlled trial on erythropoietin and blood salvage as transfusion alternatives using a restrictive transfusion policy in erythropoietin-eligible patients. Anesthesiology, 2014, 120(4):839-851.
11. Laffosse JM, Minville V, Chiron P, et al. Preoperative use of epoietin beta in total hip replacement:a prospective study. Arch Orthop Trauma Surg, 2010, 130(1):41-45.
12. Tomeczkowski J, Stern S, Müller A, et al. Potential cost saving of Epoetin alfa in elective hip or knee surgery due to reduction in blood transfusions and their side effects:a discrete-event simulation model. PLoS One, 2013, 8(9):e72949.
13. Deutsch A, Spaulding J, Marcus RE. Preoperative epoetin alfa vs autologous blood donation in primary total knee arthroplasty. J Arthroplasty, 2006, 21(5):628-635.
14. Keating EM, Callaghan JJ, Ranawat AS, et al. A randomized, parallel-group, open-label trial of recombinant human erythropoietin vs preoperative autologous donation in primary total joint arthroplasty:effect on postoperative vigor and handgrip strength. J Arthroplasty, 2007, 22(3):325-333.
15. Keating EM, Ritter MA. Transfusion options in total joint arthroplasty. J Arthroplasty, 2002, 17(4 Suppl 1):125-128.
16. Nelson CL, Fontenot HJ, Flahiff C, et al. An algorithm to optimize perioperative blood management in surgery. Clin Orthop Relat Res, 1998, (357):36-42.
17. 国家卫生和计划生育委员会. 临床输血技术规范. 柳州医学, 2012, 25(1):75-77.
18. Zohar E, Fredman B, Ellis M, et al. A comparative study of the postoperative allogeneic blood-sparing effect of tranexamic acid versus acute normovolemic hemodilution after total knee replacement. Anesth Analg, 1999, 89(6):1382-1387.
19. Messmer K. Hemodilution-possibilities and safety aspects. Acta Anaesthesiol Scand Suppl, 1988, 89:49-53.
20. Martin E, Hansen E, Peter K. Acute limited normovolemic hemodilution:a method for avoiding homologous transfusion. World J Surg, 1987, 11(1):53-59.
21. Oishi CS, D'Lima DD, Morris BA, et al. Hemodilution with other blood reinfusion techniques in total hip arthroplasty. Clin Orthop Relat Res, 1997, (339):132-139.
22. Segal JB, Blasco-Colmenares E, Norris EJ, et al. Preoperative acute normovolemic hemodilution:a meta-analysis. Transfusion, 2004, 44(5):632-644.
23. Goodnough LT, Monk TG, Despotis GJ, et al. A randomized trial of acute normovolemic hemodilution compared to preoperative autologous blood donation in total knee arthroplasty. Vox Sang, 1999, 77(1):11-16.
24. Sabatini L, Atzori F, Revello S, et al. Intravenous use of tranexamic acid reduces postoperative blood loss in total knee arthroplasty. Arch Orthop Trauma Surg, 2014, 134(11):1609-1614.
25. Alshryda S, Sukeik M, Sarda P, et al. A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. Bone Joint J, 2014, 96-B(8):1005-1015.
26. Fiechtner BK, Nuttall GA, Johnson ME, et al. Plasma tranexamic acid concentrations during cardiopulmonary bypass. Anesth Analg, 2001, 92(5):1131-1136.
27. Panteli M, Papakostidis C, Dahabreh Z, et al. Topical tranexamic acid in total knee replacement:a systematic review and meta-analysis. Knee, 2013, 20(5):300-309.
28. Camarasa MA, Ollé G, Serra-Prat M, et al. Efficacy of aminocaproic, tranexamic acids in the control of bleeding during total knee replacement:a randomized clinical trial. Br J Anaesth, 2006, 96(5):576-582.
29. Whitehead DJ, MacDonald SJ. TKA sans tourniquet:let it bleed:opposes. Orthopedics, 2011, 34(9):e497-499.
30. Tai TW, Chang CW, Lai KA, et al. Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty:a randomized controlled trial. J Bone Joint Surg (Am), 2012, 94(24):2209-2215.
31. Alcelik I, Pollock RD, Sukeik M, et al. A comparison of outcomes with and without a tourniquet in total knee arthroplasty:a systematic review and meta-analysis of randomized controlled trials. J Arthroplasty, 2012, 27(3):331-340.
32. Harvey EJ, Leclerc J, Brooks CE, et al. Effect of tourniquet use on blood loss and incidence of deep vein thrombosis in total knee arthroplasty. J Arthroplasty, 1997, 12(3):291-296.
33. Tai TW, Lin CJ, Jou IM, et al. Tourniquet use in total knee arthroplasty:a meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2011, 19(7):1121-1130.
34. Zan PF, Yang Y, Fu D, et al. Releasing of tourniquet before wound closure or not in total knee arthroplasty:a meta-analysis of randomized controlled trials. J Arthroplasty, 2015, 30(1):31-37.
35. Kubota R, Nozawa M, Matsuda K, et al. Combined preoperative autologous blood donation and intra-operative cell salvage for hip surgery. J Orthop Surg (Hong Kong), 2009, 17(3):288-290.
36. Moonen AF, Knoors NT, van Os JJ, et al. Retransfusion of filtered shed blood in primary total hip and knee arthroplasty:a prospective randomized clinical trial. Transfusion, 2007, 47(3):379-384.
37. Martin A, von Strempel A. Transfusion of autologous blood from reinfusion systems in total knee arthroplasty. Int Orthop, 2006, 30(6):541-544.
38. Singh VK, Singh PK, Javed S, et al. Autologous transfusion of drain contents in elective primary knee arthroplasty:its value and relevance. Blood Transfus, 2011, 9(3):281-285.
39. Sarkanović ML, Gvozdenović L, Savić D, et al. Autologous blood transfusion in total knee replacement surgery. Vojnosanit Pregl, 2013, 70(3):274-278.
40. Matsuda K, Nozawa M, Katsube S, et al. Activation of fibrinolysis by reinfusion of unwashed salvaged blood after total knee arthroplasty. Transfus Apher Sci, 2010, 42(1):33-37.
41. Al-Zahid S, Davies AP. Closed suction drains, reinfusion drains or no drains in primary total knee replacement? Ann R Coll Surg Engl, 2012, 94(5):347-350.
42. Napolitano LM, Kurek S, Luchette FA, et al. Clinical practice guideline:red blood cell transfusion in adult trauma and critical care. J Trauma, 2009, 67(6):1439-1442.
43. Robinson PM, Obi N, Harrison T, et al. Changing transfusion practice in total hip arthroplasty:observational study of the reduction of blood use over 6 years. Orthopedics, 2012, 35(11):e1586-1591.
44. Goodnough LT, Maggio P, Hadhazy E, et al. Restrictive blood transfusion practices are associated with improved patient outcomes. Transfusion, 2014, 54(10 Pt 2):2753-2759.

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PERIOPERATIVE BLOOD MANAGEMENT STRATEGIES FOR JOINT ARTHROPLASTY

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