Blood Transfusion In Hip And Knee Joint Replacement Surgery

摘要

Introduction Orthopaedic surgery consumes a considerable proportion of blood available to the National Health Service. Effective and judicious management of available blood is therefore vital. In order to review the usage of packed red cells in our centre, we carried out an audit involving patients who underwent total hip and knee replacement.Methods A retrospective audit was carried out to include all patients who underwent elective total hip and knee replacement, and underwent blood transfusion. A total of 449 patients were included and those who underwent transfusion were identified.Results Sixty five patients (14.5%) underwent blood transfusion. Approximately 5% required blood transfusion in both primary and revision TKR. 16% transfused in uncemented primary THR. 27.3% transfused in cemented primary THR. 30.7% transfused in uncemented revision THR. 77.7% transfused in cemented revision THR. 133 units were transfused in total out the 198 requested.Conclusion The present audit demonstrates that the cross matched to transfused ratio is within 2:1. Efforts should be made to reduce it to 1:1 where transfusion is necessary. This will aid in not only reducing the cost of transfusion, but also in reducing the risks associated with blood transfusion. Introduction Hip and knee joint replacements are very common and very successful orthopaedic procedures and the numbers done are increasing year on year. This is partly to do with the fact that it is being done in much younger age groups than before and due to the increase in the aging population. It is estimated that by 2033, 23% of the population will be aged 65 and above.1 Orthopaedic surgery consumes a considerable proportion of blood available to the National Health Service. It has been reported to be in the range of 10 – 15%.2,3 The increasing demand will further burden the National Blood service.Blood transfusion is accompanied by potentially fatal hazards.4 Although the risk of infection contracted through blood transfusion is declining, the non infectious serious hazards of transfusion will contribute to the morbidity and mortality associated with transfusion. It is also predicted that this might remain as a leading cause in the coming years.5 Effective and judicious management of available blood is therefore vital and should become part of joint replacement surgery.In order to review the usage of packed red cells in our centre, we carried out an audit involving patients undergoing elective total hip (THR) and total knee (TKR) joint replacement. The aim of the audit was to assess the extent of red cells being used and to compare it to other studies and also to serve as a baseline for future audits in our department. Methods A retrospective audit was carried over a 6 month period between February 2008 and July 2008. A full list of patients who underwent elective THR and TKR was obtained. All patients who underwent blood transfusion were identified from the hospital transfusion register. Four hundred and forty nine patients were included in this audit.The trust guidelines for transfusion in surgical patients at the time of audit were that If pre op Haemoglobin (Hb) is less than 8g/dl & the surgery is associated with probability of significant blood loss (no time to raise Hb by other means) Pre op anaemia must be investigated Post –operative Hb falls below 8g/dl and the patient is distressed or actively bleeding Results Out of 449 patients, 65(14.5%) underwent blood transfusion. One hundred and thirty three units were transfused in total out the 198 requested. According to the procedure, results are as follows. Figure 1 and 2 shows the units transfused and the percentage of blood used in total.