Preoperative haematinics and transfusion protocol reduce the need for transfusion after total knee replacement

AbstractBackgroundUnilateral total knee replacement (TKR) can result in a substantial blood loss and 30–50% of these patients receive allogeneic blood transfusion (ABT), this transfusion rate may be even higher among anaemic patients.Patients and methodsWe assessed the requirements for ABT in 156 consecutive patients undergoing surgery for primary TKR, who received iron ferrous sulphate (256mg/day; 80mg of Fe2+), vitamin C (1000mg/day) and folic acid (5mg/day) during the 30–45days preceding surgery, and who were transfused if Hb <80g/L and/or clinical signs/symptoms of acute anaemia/hypoxemia (Group 2). A previous series of 156 TKR patients serves as a control group (Group 1).ResultsCompared to those in Group 1, patients in Group 2 presented a lower transfusion rate (5.8% vs. 32%, for Group 2 and Group 1, respectively; p<0.01), and a lower transfusion index (1.78±0.44 vs. 2.22±0.65 units per transfused patient, respectively; p<0.05). After patient's stratification according to a preoperative Hb above or below 130g/L, the differences in transfusion rate remained significant, although 19% of patients from Group 2 still needed ABT if their preoperative Hb