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Minerva Ortopedica e Traumatologica 2004 April;55(2):37-43

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: Italian

Blood management in orthopedic surgery

Blonna D. ¹, Calvi V. ², La Russa M. ¹, Marmotti A. ¹, Castoldi F. ¹

¹ Divisione Universitaria di Ortopedia e Traumatologia Ospedale Mauriziano Umberto I, Torino 2 Servizio di Anestesia e Rianimazione Ospedale Mauriziano Umberto I, Torino

Recent advances in matters of the safe utilisation of homologous blood and human recombinant erythroprotein (Epoetin a), the widespread and at times unjustified diffusion of the predeposit of autologous blood, together with the ever greater attention being paid to the cost-benefit ratio, have given way to a re-evaluation of blood management strategies. In the light of recent Consensus Conferences, the use of homologous blood should be limited to cases of important and unpredictable blood losses, transfusing at haemoglobin (Hb) values of <9 g/dl. Predeposit must be confined to operations where resort to homologous transfusions in patients with Hb >13 g/dl is highly probable, optimising the time between predeposit and operation, in order to reduce the indirect cost of the technique and increase its effectiveness. In young patients with a high hematocrit value, candidates for orthopedic operations where a loss of about 1.5-2 l of blood is expected, acute normovolaemic hemodilution may be utilised as an alternative to the predeposit, as this has similar effectiveness but lower costs. All techniques must be accompanied by perioperative recovery of blood using the stand-by technique. In patients with Hb <13 g/dl the use of human recombinant erythropotein must be taken into consideration because, for values of Hb between 10 g/dl and 13 g/dl, it has proved effective in reducing resort to homologous transfusions and, values of Hb between 11 g/dl and 13 g/dl, it has proved more effective than the predeposit in patients subjected to total hip joint replacement surgery.