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Departments of *Anesthesiology and Critical Care and
Orthopedic Surgery, Trousseau University Hospital, Tours, France
Address correspondence and reprint requests to Dr. Claude Couvret, MD, Department of Anesthesiology and Critical Care, Trousseau University Hospital, 37044 Tours Cedex 1, France. Address email to fusciardi{at}med.univ-tours.fr
A limitation of preoperative autologous blood donation (PABD) in nonanemics and the use of recombinant human erythropoietin (EPO) in anemics (baseline hematocrit [Hct] 
39%) could be an efficient approach of the cost-benefit ratio of transfusion during primary total hip (THA) or knee (TKA) arthroplasties. We evaluated the consequences on transfusion rates and costs of two different applications of a transfusion policy based on personal requirements during primary THA or TKA. This quality assurance observational study compared two prospective successive time periods; each included successive patients treated by the same medical team and standardized care. In Study 1 (n = 182), PABD was indicated if there were insufficient estimated red blood cell reserve and a life expectancy 
10 yr, no use of EPO, and identical criteria for any transfusion. Because this policy led to a 50% allogeneic transfusion rate when baseline Hct 37% and autologous blood wastage in the nonanemics (baseline Hct > 39%), 2 refinements were introduced in Study 2 (n = 708): EPO without PABD when baseline Hct 37%, and life expectancy 10 yr, and avoidance of PABD in nonanemics. This novel care induced a marked decrease in transfusion rates (respectively, from 41% to 7%, P < 0.0002, in nonanemics; from 58% to 27%, P < 0.003, in anemics; and from 43% to 12%, P < 0.0001, overall), with no change in allogeneic transfusion (10%) and discharge Hct, and a 39% financial savings. This saving effect is a result of the suppression of PABD in nonanemics, who represent 75% of this surgical population. Although erythropoietin is expensive, it can be used with cost savings in selected patients because the overall cost of transfusion is reduced.
IMPLICATIONS: During primary total hip or knee arthroplasty, the limitation of erythropoietin to patients with hematocrit 37%, the restrictive use of autologous donation to patients with 37% < hematocrit 39% and no autologous donation in the nonanemics may allow savings both in blood requirements and financial cost.
This article has been cited by other articles:
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  V. Martinez, A. Monsaingeon-Lion, K. Cherif, T. Judet, M. Chauvin, and D. Fletcher Transfusion strategy for primary knee and hip arthroplasty: impact of an algorithm to lower transfusion rates and hospital costs Br. J. Anaesth., December 1, 2007; 99(6): 794 - 800. [Abstract] [Full Text] [PDF]
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