A protocol avoiding allogeneic transfusion in joint arthroplasties

Abstract

INTRODUCTION: Arthroplasties of hip and knee are associated with blood loss, which may lead to adverse patient outcome. Performing arthroplasties in Jehovah's Witness patients who do not accept transfusion has been a matter of concern. We developed a protocol, which avoids transfusion in arthroplasties of Jehovah's Witness patients, and evaluated the feasibility and safety of the protocol. MATERIALS AND METHODS: The target of preoperative hemoglobin was more than 10g/dL. When preoperative hemoglobin was lower than 10g/dL, 4000 U erythropoietin (3 times a week) and 100mg iron supplement (every day) were administered until the hemoglobin reached 10g/dL. When the preoperative hemoglobin was higher than 10g/dL, 4000U erythropoietin and 100mg iron supplement were administered once, before operation. During the operation, cell saver was used. Postoperatively, erythropoietin and iron supplements were administered until the hemoglobin reached 10g/dL, similar to the preoperative protocol. We evaluated the feasibility of our protocol, perioperative complications and hematologic changes. RESULTS: From 2002 to 2014, 186 Witness patients visited our department. In 179 patients (96.2%), 77 total knee arthroplasties, 69 bipolar hemiarthroplasties and 33 total hip arthroplasties were performed. The mean hemoglobin level was 12.3g/dL preoperatively, 9.4g/dL on postoperative day 3 and 10.3g/dL on postoperative day 7. One patient died immediately after the arthroplasty and the remaining 178 patients survived. CONCLUSIONS: Total joint arthroplasty could be done without transfusion using this protocol in most of our patients. The rates of infection and mortality were similar with known infection and mortality rates of arthroplasties. In patients who do not want allogeneic transfusions, our protocol is a safe alternative to perform joint arthroplasties.