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Objectives. Local corticosteroid infiltration is a common practice of treatment for lateral epicondylitis. In recent studies no statistically significant or clinically relevant results in favour of corticosteroid injections were found. The injection of autologous blood has been reported to be effective for both intermediate and long-term outcomes. It is hypothesised that blood contains growth factors, which induce the healing cascade. Methods. A total of 60 patients were included in this prospective randomised study: 30 patients received 2 ml autologous blood drawn from contralateral upper limb vein + 1 ml 0.5% bupivacaine, and 30 patients received 2 ml local corticosteroid + 1 ml 0.5% bupivacaine at the lateral epicondyle. Outcome was measured using a pain score and Nirschl staging of lateral epicondylitis. Follow-up was continued for total of six months, with assessment at one week, four weeks, 12 weeks and six months. Results. The corticosteroid injection group showed a statistically significant decrease in pain compared with autologous blood injection group in both visual analogue scale (VAS) and Nirschl stage at one week (both p < 0.001) and at four weeks (p = 0.002 and p = 0.018, respectively). At the 12-week and six-month follow-up, autologous blood injection group showed statistically significant decrease in pain compared with corticosteroid injection group (12 weeks: VAS p = 0.013 and Nirschl stage p = 0.018; six months: VAS p = 0.006 and Nirschl p = 0.006). At the six-month final follow-up, a total of 14 patients (47%) in the corticosteroid injection group and 27 patients (90%) in autologous blood injection group were completely relieved of pain. Conclusions. Autologous blood injection is efficient compared with corticosteroid injection, with less side-effects and minimum recurrence rate


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_15 | Pages 275 - 275
1 Mar 2013
Murphy W Gulczynski D Bode R Murphy S
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Introduction. Early rehabilitation and discharge following minimally-invasive total hip arthroplasty has potential risks including the possibility that patients may become progressively anemic at home. The current study assess the use of pre-emptive autologous blood transfusion on the length of stay, readmission, and allogenous transfusion. Methods. Patients treated by primary total hip arthroplasty using the superior capsulotomy technique were studied. Patients were divided into two groups. Group 1 were patients who did donate autologous blood and received an intra-operative pre-emptive transfusion. There were 283 patients in Group 1. Group 2 were patients who were medically capable of donating autologous blood but did not for non-medical reasons. There were 71 patients in Group 2. Patients who did not donate autologous blood for medical reasons (preoperative Hgb less than 11.5, age over 80) were excluded. All patients received general anesthesia. Length of stay, allogenous transfusion and readmission were compared. Results. The mean length of stay after surgery for the Group 1 patients who received autologous blood donation during primary THA was 1.56 days (SD 78 days, range 0–4). The mean length of stay for the Group 2 patients who did not donate or receive autologous blood during primary THA was 1.87 days (SD 84 days, range 1–4). Patients who received autologous blood donation had a significantly shorter post-surgical length of stay than patients who did not (p = .002, Mann-Whitney test). Patients who did not donate and preemptively receive autologous blood received significantly more allogenous blood (Mann-Whitney, p=.0004). Moreover 15% of those who auto-donated were given allogenic transfusions, while 37% of those who did not auto-donate were given allogeneic transfusions. One patient who did receive autologous transfusion and was discharged on day 2 sustained an NSAID induced GI-bleed 3 weeks postop and was admitted for transfusion and treatment. There were no other readmissions in either group. Conclusions. Patients who receive pre-emptive autologous blood transfusion intra-operatively when treated specifically by total hip arthroplasty using the superior capsulotomy technique under general anesthesia have shorter hospital stays and lower allogenous transfusion rates than a matched cohort of patients that did not donate and receive autogenous blood


Bone & Joint Research
Vol. 9, Issue 7 | Pages 402 - 411
1 Aug 2020
Sanghani-Kerai A Coathup M Brown R Lodge G Osagie-Clouard L Graney I Skinner J Gikas P Blunn G

Aims. For cementless implants, stability is initially attained by an interference fit into the bone and osteo-integration may be encouraged by coating the implant with bioactive substances. Blood based autologous glue provides an easy, cost-effective way of obtaining high concentrations of growth factors for tissue healing and regeneration with the intention of spraying it onto the implant surface during surgery. The aim of this study was to incorporate nucleated cells from autologous bone marrow (BM) aspirate into gels made from the patient’s own blood, and to investigate the effects of incorporating three different concentrations of platelet rich plasma (PRP) on the proliferation and viability of the cells in the gel. Methods. The autologous blood glue (ABG) that constituted 1.25, 2.5, and 5 times concentration PRP were made with and without equal volumes of BM nucleated cells. Proliferation, morphology, and viability of the cells in the glue was measured at days 7 and 14 and compared to cells seeded in fibrin glue. Results. Overall, 2.5 times concentration of PRP in ABG was capable of supporting the maximum growth of cells isolated from the BM aspirate and maintain their characteristics. Irrespective of PRP concentration, cells in ABG had statistically significantly higher viability compared to cells in fibrin glue. Conclusion. In vitro this novel autologous gel is more capable of supporting the growth of cells in its structure for up to 14 days, compared to commercially available fibrin-based sealants, and this difference was statistically significant. Cite this article: Bone Joint Res 2020;9(7):402–411


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 18 - 18
1 Mar 2006
Pitsaer E
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The management of autologous blood aims at reducing the need for allogenic transfusion. Blood requirement (autologous and/or allogenic) will depend on the pre-operative red blood cell stock and on the perioperative blood loss. The red cell stock is related to body weight and preoperative haemoglobin (haematocrit) level; it can be calculated accurately, whereas the perioperative blood loss (external and occult) is variable and unpredictable. Preoperative donation of autologous blood, as well as intraoperative and/or postoperative recuperation and reinfusion of shed blood decrease the risk for allogenic transfusion in total hip replacement (THR) and total knee replacement (TKR) surgery. However, their efficiency and cost effectiveness are not optimal when applied to unselected patients. Up to 50% of the predonated units of autologous blood are wasted after THR and THK surgery if patients have not been specifically selected to predonate blood. In hip surgery the volume reinfused after intraoperative blood recuperation obviously depends on intraoperative bleeding; it averages 500 ml in a hip revision operation. In TKR (with a tourniquet) the volume reinfused after postoperative recuperation depends on the amount of blood drained in the immediate postoperative period, which reflects both the amount of bleeding and the efficiency of the drainage. On average, 500 ml of shed blood with a haematocrit of 35% is reinfused, which increases the haemoglobin level by 1.0 gr/dl on average. The efficiency of this technique is unpredictable, with a wide dispersion of individual values (standard deviation: 208 ml) for the volumes reinfused. However, in patients with a body weight of 70 kg or less, the increase in haemoglobin level was more predictable and averaged 1.23 gr/dl. In order to improve the efficiency of these two techniques (preoperative autologous blood donation and recuperation/reinfusion of shed blood), patients need to be targeted, taking into account:. - the calculated preoperative (day before surgery) red blood cell stock and the number of units of predonated blood,. - the lowest postoperative haemoglobin and haematocrit level clinically tolerable for that specific patient,. - the expected perioperative blood loss, which depends on such factors as duration of surgery, anticoagulant administration, use of a tourniquet,etc). As a general rule, a haemoglobin level < 13 gr/dl, age > 65 years and weight < 70 kg all increase the risk to require autologous or allogenic blood transfusion, and would justify planning predonation of blood and/or recuperation/reinfusion of shed blood


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 424 - 424
1 Sep 2012
Antonarakos P Christodoulou A Givissis P Katranitsa L Simeonidis P Boutsiadis A
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AIM. Retrospective study comparing the effectiveness of preoperative autologous blood donation versus intra-operative blood saver systems in minimizing the need for allogeneic blood transfusion in scoliosis surgery. MATERIALS – METHODS. Between 2003–2009, 37 of the patients (4–33, mean age 20y) who underwent scoliosis surgery, were divided in two groups. The first group (20 patients, mean age 18.7y) underwent autologous blood predonation, prerequisities were body weight over 50 kgr and Hgb above 11 mg/dl. The second group (17 patients, mean age 21.5y) consisted of patients who did not meet the above prerequisities and blood saver was used intra-operatively. Duration of surgery and perioperative Haemoglobulin (Hgb) levels were recorded in both groups. RESULTS. In group A an average of 4 autologous blood units per patient were predonated (3–5 units/patient) and the mean transfusion rate was 3.4 autologous blood units/patient. Only one patient was transfused with one allogeneic blood unit while of the 81 predeposited autologous blood units 15 were wasted (18.5%). In Group B intra-operative autotransfusion systems salvaged 302.9 ml/patient (150–500 ml/patient) while the mean transfusion rate was 2.1 allogeneic blood units/patient. CONCLUSIONS. The use of intra-operative autotransfusion systems seems to reduce the need for allogeneic blood transfusion when compared with preoperative autologous blood donation. However, the lower preoperative Hgb in Group B have to be taken under consideration. Further studies need to prove the effectiveness of these methods so that perioperative blood management minimizes the need for allogeneic blood transfusion in scoliosis surgery


The Journal of Bone & Joint Surgery British Volume
Vol. 83-B, Issue 5 | Pages 676 - 679
1 Jul 2001
Bae H Westrich GH Sculco TP Salvati EA Reich LM

We have assessed the effect of the donation of autologous blood and the preoperative level of haemoglobin on the prevalence of postoperative thromboembolism in 2043 patients who had a total hip arthroplasty. The level of haemoglobin was determined seven to ten days before surgery and all patients had venography of the operated leg on the fifth postoperative day. The number of patients who had donated autologous blood (1037) was similar to that who had not (1006). A significant decrease in the incidence of deep-vein thrombosis (DVT) was noted in those who had donated blood preoperatively (9.0%) compared with those who had not (13.5%) (p = 0.003). For all patients, the lower the preoperative level of haemoglobin the less likely it was that a postoperative DVT would develop. Of those who had donated blood, 0.3% developed a postoperative pulmonary embolism compared with 0.7% in those who had not, but this difference was not statistically significant. No significant difference was found in the requirements for transfusion between the two groups


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_II | Pages 271 - 272
1 May 2006
Choudry Q Siddique I Eastwood G Mohan R
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Introduction: Blood conservation has rapidly moved into political and medical agendas. The ongoing shortage of blood in blood banks and the discovery of vCJD pose a threat to UK blood supply with ever rising costs. The use of blood conservation techniques is increasingly being used in surgery to help reduce the need for homologous blood. We studied the use of Autologous blood transfusion drains (Bellovac ABT) in lower limb arthroplasty compared with standard closed suction drains. We studied 123 lower limb arthroplasty (61 TKR & 62 THR) to see if there was a significant reduction in the need for homologous blood transfusion when using re-transfusion drains and its cost effectiveness. Methods: Retrospective analysis of 123 patients undergone lower limb arthroplasty from March 2002 to Dec 2004 under one surgeon using the same technique for TKR and THR. 61 TKR (30 ABT drains v 31 standard drain) and 62 THR (30 ABT drains v 32 standard drain). Data was collected on sex, age, pre & post op Hb, volumes drained, volumes re-transfused and the number of homologous blood transfusions. Results: 30 THR with ABT drains: 14 male, 16 female, mean age 68.7, mean pre op Hb 13.67, mean post op Hb 10.55,mean volume re-transfused 324ml, mean volume drained 466ml. 7 patients(23%) required additional homologous blood transfusion. 32 THR with standard drains: 14 male, 18 female, mean age 68.4, mean pre op Hb 12.96, mean post op Hb 9.36, mean volume drained 579.5ml. 24 patients (75%) required homologous blood transfusion. 30 TKR with ABT drains: 14 male, 16 female, mean age 69.8, mean pre-op Hb13.4, mean post-op Hb 11.03, mean volume re-transfused 415ml, mean volume drained 580ml. 4 patients (13%) required additional homologous blood transfusion. 31 TKR with Standard drains: 13 male, 18 female. Mean age72.1, mean pre-op Hb13.33, mean post-op Hb10.4, mean volume drained 711.5ml. 14 patients (45%) required homologous blood transfusion. No re-transfusion complications occurred in the ABT group. 2 patients requiring homologous blood had increasing pyrexia and transfusion hence stopped. Discussion: 11 out of 60 patients (18%) using ABT drains required additional homologous blood compared with 38 out of 63 patients (60%) requiring homologous blood using standard drains. Pvalue< 0.001. We show a stastically significant reduction in the need for homologous blood transfusion using an autologous blood re-transfusion drain. One unit of blood costs approximately £120 the ABT drain less than half of this amount, there is a significant cost saving in using autologous blood re-transfusion drains. We conclude that using Autologous blood Re-transfusion drains is safe, cost effective and reduces the need for homologous blood transfusion. If drains are to be used then Re-transfusion drains should be used


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_III | Pages 322 - 322
1 Nov 2002
Sethi R Bagga TK
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Introduction: Total Knee Replacement is a commonly done planned operative procedure frequently requiring blood transfusion. Fear of adverse reactions, transmission of viral illnesses like AIDS, Hepatitis B, C and Non A Non B has led to interest in alternatives to allogenic blood transfusion. Predonation of autologous blood, administration of erythropoeitin alpha, postoperative blood recovery using cell saver or suction devices for reinfusion of whole blood have all been suggested to overcome this problem. Aim: Our study was aimed to assess the efficacy of reinfusion of autologous blood transfusion from the blood collected after completion of the surgical procedure using Constavac reinfusion drain system. Method: A prospective analysis of 54 patients undergoing primary total knee replacement was done. All patients with preoperative Hb of 12.5gm/dl or more were included. Postoperative drop in Hb below 9 gm/dl was an indication of supplemental transfusion. Probability of sepsis or malignancy were criterion for exclusion. Results: In all patients undergoing Total knee replacement , average amount of blood reinfused was 480 mls. 50 of the 54 (92.6%) patients did not need any homologous blood transfusion. Average drop in Hb was 2.3 gm/dl. In nine patients (16.7%) there was drop in Hb of more than 3 gm% but only three of them needed blood transfusion. Patients with valgus deformity and needing lateral release were more at risk of needing homologous blood transfusion. No complications or adverse effects were noticed. Discussion: Our study shows that reinfusion alone may be sufficient in most cases needing Total knee replacement. It is a reliable, safe, simple and cost effective way to overcome the need of allogenic blood transfusion in patients undergoing Total Knee Replacement. This may reduce the load on blood banks for cross matching all patients undergoing knee replacement except in valgus knees


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_III | Pages 232 - 233
1 Mar 2003
Christodoulou A Terzidis Savvidis P Alemachou TM Manitsa A
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Purpose: The efficacy of a programme transfusion of pre-deposited autologous blood for patients undergoing total hip or knee replacement and scoliosis or other major spinal surgery was studied. Materials and Methods: Seventy-three patients 56 women and 17 men with an average 39 years (range 14 – 72) entered this program between 1997–2001. According to the surgical necessities predisposition started 2 to 5 weeks preoperatively (one unit per week). The blood bank required that the patients weight more than 40 kilograms and have a haemoglobin mare than 11,5 g/dl. All patients received supplemental ferrous sulfate or ferrous gluconate in dose of 325 mgr three times a day, during the duration period and up to one month postoperatively. Eighty five percent of the patients prede-posited the required number of blood units (2–5 units) while 15% of them predeposited a smaller number due to various reasons (anaemia, low blood pressure etc). The blood was stored for as long as forty-two days. Only three patients refused continuation of the prograrnme. No major problem was observed during blood donation. One hundred percent of the psedeposited blood units were reinfused and in only 7 patients homologous blood transfusion was required. Conclusion: The method proved to be simple, safe very well accepted and reduced significantly the need homologous blood transfusion. It should be considered for patients who are to undergo a major Orthopaedic procedure


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 87 - 87
1 Sep 2012
Mertes S Raut S Khanduja V
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Aim. The aim of this study was to determine the effects of using the Bellovac autologous blood salvage system on blood transfusion requirements, adverse event rate, post-operative length of stay (POLOS) and mobilisation in patients who have undergone a total knee replacement. Methods. This is a retrospective cohort study of 471 patients who underwent a total knee replacement (TKR) at our institution between January 2008 and August 2009. All patients received an autologous blood salvage drain in theatre. Their medical records were reviewed and a database created to assess the efficacy of the blood salvage system. Results. Overall 70% of the patients were re-transfused (77% of males, 65% of females). In the remainder there was too little blood in the drain by the time the re-transfusion window had ended. Re-transfused patients were comparable to those not re-transfused in terms of age, BMI, comorbidity, pre-op mobility, anaesthetic type and pre-operative haemoglobin concentration. Re-transfused patients had lower allogeneic transfusion requirements (6.5 vs 12.9%, p=0.022). This was not a result of the gender discrepancy. Number needed to treat with a re-infusion drain was 8.9 (95%CI 5.8–19.3) to prevent one unit of allogeneic blood being transfused. Re-transfused patients also had a lower post-operative adverse event rate (18 vs 24% p=0.18) but this was not statistically significant. POLOS and post-operative mobilisation were not affected, even after the elimination of patients with adverse events. Cost analysis showed that autologous re-infusion drains (£50 each) were not cost-effective in preventing allogeneic blood transfusion (vein-to-vein cost £135). One adverse event attributable to the re-infusion system occurred: a drain tip had to be removed operatively after becoming bent. Conclusion. Autologous re-infusion systems are effective but not cost-effective in reducing blood transfusion requirement after TKR. Autologous re-infusion may be associated with a reduced adverse event rate post-operatively


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_II | Pages 181 - 182
1 Apr 2005
Regis D Franchini M Corallo F Carità E Bartolozzi P
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Preoperative autologous blood donation (PABD) is widely practised in elective orthopaedic surgery, but few data are available as regards recombinant human erythropoietin (rHuEpo) support during a PABD programme in children. In January 1999 we introduced a PABD protocol with erythropoietin (10000 U s.c. twice weekly during the 3 weeks preceding surgery) in children who were scheduled for corrective surgery of scoliosis. Between January 1999 and November 2003, 23 consecutive patients (five males and 18 females, median age 15.1 years) were enrolled. Preoperative haemoglobin (Hb) levels, the numbers of collected and of autologous and allogeneic blood transfused units were determined. The results were compared with a historical group of 28 consecutive patients (seven males and 21 females, median age 15.4 years) who underwent spinal surgery between January 1994 and December 1998 and who differed from the first group only by the absence of concomitant erythropoietin therapy. Administration of rHuEpo allowed all patients to complete the PABD programme, whereas 36% of patients in the non-treated group had to stop predeposit because they developed anaemia. Furthermore, significantly higher numbers of collected blood units and haemoglobin levels were measured. A significantly lower requirement for allogeneic blood was observed in the rHuEpo-treated group: 1/23 vs. 9/28 patients (4.3%–32.1%, p < 0.001). The present study documents the efficacy of presurgical rHuEpo in facilitating autologous blood collection, thus reducing exposure to allogeneic blood, in paediatric patients undergoing corrective spinal surgery


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 146 - 146
1 Mar 2006
Mirza A Aldlyame E Bhimarasetty C Spilsbury J Marks D
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Anterior scoliosis surgery is associated with potentially significant intra-operative blood loss, requiring homologous transfusion either intra- or post-operatively. Blood loss in this type of surgery correlates with surgical & anaesthetic techniques. In our centre the development of specific anaesthetic techniques as well as the routine use of Cell Salvage has dramatically reduced the rates of homologous blood transfusion. Currently specific indications for the use of the Cell Saver in Anterior Scoliosis have not been proven. Previous studies have commented on the beneficial aspects of recovered autologous transfusion for Orthopaedic patients in general, whilst others have shown a negligible advantage specifically in anterior thoracolumbar fusion surgery. In order to assess the cost-effectiveness of the techniques used in Anterior Scoliosis Surgery we carried out a retrospective study of 180 consecutive patients, all of whom underwent instrumented anterior scoliosis correction between July 2000 and September 2004. A cell saver was used in all the cases, and hospital data (including haematological indices and number of levels fused) was collected. The median age of the study cohort was 11.2 years (range 7 – 64), and the male:female ratio was 1:8.4. The average preoperative haemoglobin in all patients was 12.7g/dl and the average postoperative haemoglobin was 9.8g/dl. In total the rate of homologous transfusion requirement was 1 unit per 9.1 patients. Results show that homologous transfusion was required in less than 11% of all patients. This is better than previously published rates of transfusion in similar procedures. The range of volume of intra-operatively salvaged cells was 200 to 770mls. There was no correlation between the number of levels fused (extent of scoliosis corrective surgery) and units transfused. Our experience shows that the use of Salvaged Autologous Blood Transfusion in anterior scoliosis surgery has an important role in reducing the incidence of postoperative anaemia and homologous transfusion requirements


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_12 | Pages 12 - 12
1 Mar 2013
Tang Q Silk Z Hope N Ha J Ahluwalia R Williams A Gibbons C Church J
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To date, there are no clear guidelines from the National Institute of Clinical Excellence or the British Orthopaedic Association regarding the use of Autologous Blood Transfusion (ABT) drains after elective primary Total Knee Replacement (TKR). There is little evidence to comparing specifically the use of ABT drains versus no drain. The majority of local practice is based on current evidence and personal surgical experience. We aim to assess whether the use of ABT drains effects the haemoglobin level at day 1 post-operation and thus alter the requirement for allogenic blood transfusion. In addition we aim to establish whether ABT drains reduce post-operative infection risk and length of hospital stay. Forty-two patients undergoing elective primary TKR in West London between September 2011 and December 2011 were evaluated pre- and post-operatively. Patient records were scrutinised. The patient population was divided into those who received no drain post-operatively and those with an ABT drain where fluid was suctioned out of the knee in a closed system, filtered in a separate compartment and re-transfused into the patient. Twenty-six patients had ABT drains and 4 (15.4%) required an allogenic blood transfusion post-operatively. Sixteen patients received no drain and 5 (31.3%) required allogenic blood. There was no statistical difference between these two groups (p=0.22). There was no statistical difference (p=0.75) in the average day 1 haemoglobin drop between the ABT drain and no drain groups with haemoglobin drops of 2.80 and 2.91 respectively. There was no statistical difference in the length of hospital stay between the 2 groups (p=0.35). There was no statistical difference (p=0.26) in infection rates between the 2 groups (2 in ABT drains Vs. 0 in no drains). Of the 2 patients who experienced complications one had cellulitis and the other had an infected haematoma, which was subsequently washed out. The results identify little benefit in using ABT drains to reduce the requirement for allogenic blood transfusion in the post-operative period following TKR. However, due to small patient numbers transfusion rates of 31.3% in the ABT drain group Vs. 15.4% in the no drain group cannot be ignored. Therefore further studies including larger patient numbers with power calculations are required before a true observation can be identified


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_II | Pages 224 - 225
1 May 2006
Mirza A Aldlyami E Bhimarasetty C Spilsbury J Marks D
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Background: Anterior scoliosis surgery is associated with potentially significant intra-operative blood loss, requiring homologous transfusion either intra- or postoperatively. Blood loss in this type of surgery correlates with surgical & anaesthetic techniques. In our centre the development of specific anaesthetic techniques as well as the routine use of Cell Salvage has dramatically reduced the rates of homologous blood transfusion. Currently, specific indications for the use of the Cell Saver in Anterior Scoliosis Surgery have not been proven. Previous studies have commented on the beneficial aspects of autologous transfusion for Orthopaedic patients in general; However, others have shown a negligible advantage specifically in anterior thoracolumbar fusion surgery. The aim of our study was to assess and quantify the use of homologous blood, as well as the effects on haematological indices. Methods: We carried out a retrospective study of 144 consecutive patients, all of whom underwent instrumented anterior scoliosis correction between April 2001 and October 2004. A cell saver was used in all the cases, and hospital data (including haematological indices and number of levels fused) was collected. Results: The median age of the study cohort was 15.0 years (range 8 – 46), and there were 31 males and 113 females. The mean preoperative haemoglobin in patients was 13.5g/dl and the mean postoperative haemoglobin was 10.6g/dl. Haematocrit values followed a similar pattern, the mean pre-op value being 0.41, mean post-op value was 0.29. The range of volume of intra-operatively salvaged cells was 200 to 1100mls. 25 of 144 patients required transfusion. In these patients, the average number of units given was 2.3, although the total homologous transfusion rate was 0.4 units per patient. Results show that homologous transfusion was not required in 82.6% of patients. This is better than previously published rates of transfusion in this procedure. There was no correlation between the number of levels instrumented and the number of units transfused (Pearson Correlation Coefficient 0.19), and no correlation between the number of levels instrumented and postoperative haematocrit values (Pearson Correlation Coefficient 0.16). None of the patients required intra-operative homologous transfusion. Conclusion: Our experience shows that along with meticulous surgical haemostasis, and hypotensive anaesthesia the use of Salvaged Autologous Blood Transfusion in anterior scoliosis surgery has an important role in reducing the incidence of postoperative anaemia and homologous transfusion requirements


We prospectively randomised 104 consecutive patients undergoing primary cemented total knee arthroplasty to receive either a standard suction drain© (Redivac) or autologous transfusion drain® (Bellovac). There were fifty two patients in each group. Randomisation was performed using a software program (Minim) which set to stratify patients based on their age, sex and body mass index (BMI). All procedures were performed under pneumatic tourniquet. Drains were released in recovery room 20 minutes after surgery and were removed 24 hours following surgery. Blood collected in the standard suction drain was discarded but blood collected in the autologous transfusion drains was transfused unwashed to the patient within six hours of collection. 13 patients (25%) in the study group had two or more units of homologous blood transfused in addition to the blood collected postoperatively and re-transfused (Average= 438mls). 12 patients (23%) in the control group had two or more units of homologous blood transfused. No sepsis, transfusion reactions, or coagulopathies were associated with the autologous blood re-transfused in the study group. The use of autologous transfusion system (Bellovac) proved to be safe but failed to reduce the need for postoperative homologous blood transfusion following uncomplicated total knee arthroplasty


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 359 - 359
1 Mar 2004
Reddy V Siddique S Siddique M
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Aims: To study whether re-transfusion of autologus blood from solcotrans drains reduced banked blood transfusion requirement in primary total knee arthroplasty (TKR). Methods: 195 patients with unilateral primary TKR using the same surgical technique and implants were prospectively reviewed. Group 1: In 120 cases, solcotrans drain system used for postoperative blood salvage and reinfusion. Group 2: 75 cases had standard redivac drains. Homologous blood transfusions used if post-operative haemoglobin < 9 gm. Factors like weight and height, and pre-operative haemoglobin levels were also studied. Results: Group 1: Average blood loss: 598 ml. 88 cases (71%) had reinfusion of autologous salvaged blood, average re-transfusion: 271 ml (range: 200 Ð 1160 ml). In 29% (32 cases), there was not enough blood in solcotrans drains for re-transfusion. 29 patients (23%) required banked blood transfusion in whom average blood loss was 720 ml, average number of units transfused: 1.6. In 10 of the 29 cases, there was not enough blood in solcotrans drains for re-transfusion. Group 2: Average blood loss: 588 ml. 20 cases (26%) required banked blood transfusion in whom average blood loss was 758 ml. Average number of units transfused: 1.9. Conclusions: In our study, solcotrans system did not reduce the requirement of banked blood transfusion signiþcantly in TKR. In both groups, low levels of preop-erative haemoglobin, low weight and amount of blood loss inßuenced banked blood requirement (p< 0.05)


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 498 - 498
1 Oct 2010
Quah C Chougle A Joshi Y Mcgraw P
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Introduction: Elective joint replacement patients routinely require transfusion following surgery. Haemoglobin must remain within red blood cells in order to be functional. The process of surgery and collection in the reinfusion drain may disrupt cell membranes resulting in non functional haemoglobin. The filtration and collection process does not eliminate free haemoglobin. This results in intracellular and free haemoglobin being transfused into patients giving false functional haemoglobin levels.

Aim: To determine the proportion of intracellular haemoglobin in autologous blood transfusion drain following joint replacement.

Research Methodology: Research ethical approval was obtained prior to conducting this study. 20 consecutive patients undergoing elective total hip replacement (THR) and 20 consecutive patients undergoing elective knee replacement (TKR) from April 08–July 08 were consented to participate in this study. A standard full blood count sample of 3 mls was taken from the rein-fused blood. Each sample had the total haemoglobin (THb) concentration determined (i.e. free and intra-cellular) from the blood in the specimen tube. The sample was then centrifuged, and the THb of the supernatant was determined. This determined the concentation of ‘free’ haemoglobin. From these two respective values, the proportion of haemolysed haemoglobin was determined from each sample.

Results: There were a total of 35 participants of which 20 were TKR and 15 were THR. The average THb concentration for the THR and TKR were 7.7g/dl and 10.3g/dl respectively. The proportion of haemolysed Hb was 1.46% and 0% respectively. The THb and proportion of haemolysed Hb for all 35 patients were 8.76g/dl and 0.63%.

Conclusion: Autologous blood transfusion is not only safe and economical but remains an effective procedure with a negligible proportion of haemolysis


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 148 - 148
1 Mar 2006
Al-Sarawan M Hussein R Mostert M Sakka S
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Aim: To establish the effectiveness of using the intra-operative cell saver in spinal surgery.

Methods: Patients undergoing posterior instrumental lumber spine fusion with iliac crest bone graft were selected to have intra-operative red cell salvage using the cell saver machine (Dideco Electra-Auto-transfusion Cell Separator). 20 patients were in the study group. The control group consisted of 28 patients who had undergone similar surgery prior to introducing the cell saver. The parameters identified were: pre and post operative haemoglobin, clotting state, volume of transfused allogenic blood, volume of transfused autollogous blood using the cell saver and indications for transfusion. Statistical analysis: the chi-square and the t-test.

Results: The average age in the cell saver group was 43.8 years and in the control group 48.3 (p> 0.09). The number of levels fused was comparable between the two groups (p> 0.1). There was no difference in the pre and post operative haemoglobin level in the two groups (p> 0.7 & p> 0.3 respectively). No patient had a pre-operative coagulopathy. Two patients (10%) in the cell saver group received an intra-operative allogenic transfusion, 14 patients (50%) in the non-cell saver group received a transfusion. The difference was significant (p< 0.004). Conclusion: The use of the cell saver significantly reduces the need for allogenic blood transfusion in major spinal surgery. We therefore recommend its routine use in such procedures.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 343 - 343
1 Mar 2004
Ho K Khan A Sochart D
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Aims: To investigate whether blood transfusion practice in primary total knee replacement (TKR) was being managed appropriately, and to assess the cost effectiveness of pre-operative autologous donation (PAD). Methods: A retrospective survey of blood transfusion practice was conducted for all TKR. The unit has an established PAD service with over 60% uptake for suitable candidates. An analysis of all pre-operative and post-operative haemoglobin concentrations (Hb) was performed. Using Hb concentration of 8 g/dl or 9 g/dl as the transfusion criteria, the total units of blood used, saved or discarded was calculated. Results: 174 TKR were performed, 84 (48%) patients were transfused. 52 patients (117 units) received allogenic blood, 35 patients (61 units) received PAD blood, 8 patients received both. 60 units (50%) of PAD were discarded. Using a level of Hb of 8 g/dl, 46 patients (96 units) would have received allogenic blood, 30 patients (51 units) would have received PAD blood and 7 patients both. 70 units (58%) of PAD would have been discarded. Using a level of Hb of 9 g/dl, 35 patients (69 units) would have received allogenic blood, 22 patients (36 units) would have received PAD blood and 6 patients both. 85 units (70%) of PAD would have been discarded. If the transfusion threshold used were < 8 g/dl and < 9 g/dl, the potential saving was estimated at approximately £9578 and £6884 respectively. Conclusions: PAD service is considerably more expensive than allogenic blood. With high percentages of PAD being discarded, the service is not cost effective. Substantial saving can be achieved with a þrmer transfusion policy for post-operative patients.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 163 - 163
1 Mar 2010
Kang S Han H Yoon K
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Primary total knee arthroplasty is associated with considerable blood loss, and allergenic blood transfusions are frequently necessary. Because of the cost and risks of allogenic blood transfusions, the autologous drainage blood reinfusion technique has been developed as an alternative. A number of studies have compared reinfusion techniques with standard suction drainage, but few reports compared with no drain use. We analyzed early results after primary total knee arthroplasty using autologous drainage blood reinfusion and no drain. We selected 30 patients who underwent primary total knee arthroplasty using no drain between November 2005 and March 2006 and matched for age and gender with 30 patients who underwent primary total knee arthroplasty using autologous drainage blood reinfusion technique between January 2003 and October 2005. All operations were done under pneumatic tourniquet and meticulous hemostasis was performed after deflation of the tourniquet. We have retrospectively reviewed the preoperative data (age, gender, body mass index, diagnosis, history of the knee surgery, infection and anticoagulant therapy, and medical cormorbidities) and the postoperative data (hemoglobin, hematocrit and platelet during hospitalization, the amount of allogenic blood transfusion and narcotics, complications, rehabilitation process, and clinical scores). All preoperative and postoperative variables except the postoperative second and seventh days hemoglobin and 2nd day hematocrit showed no significant differences between two groups. The hemoglobin and hematocrit also showed no significant differences at the postoperative fourteenth day. The autologous drainage blood reinfusion method in primary total knee arthroplasty does not have significant clinical benefit over no-drain method with regards to allogenic blood transfusions, narcotics uses, the incidence of complications and rehabilitation processes