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Transfusion Therapy


- Blood Product Menu:
      - pRBC's / Fresh Frozen Plasma / Platlets / Cryoprecipitate / Transfusion Therapy / Coag Pathway

- Indications for Blood Transfusion:

- Methods to Decrease Transfusion:
    - erythropoietin
            - The effects of recombinant human erythropoietin on perioperative transfusion requirements in patients having a major orthopaedic operation.
            - Use of erythropoietin to increase the volume of autologous blood donated by orthopedic patients.
    - iron supplementation:
            - references:
                   - Iron supplementation after femoral head replacement for patients with normal iron stores;
                   - The effect of oral iron supplementation on erythropoiesis in autologous blood donors.
    - autologous blood: (see pRBC transfusion)
            - in the THR study by Sculco and Gallina 1999, 82% of these patients (autologous or PAD patients) required transfusion of their own
                    blood (vs 50% in patients that did not donate autologous blood), but only 8% of PAD patients required allogenic transfusion;
                    - 34 to 45% of autologous blood was discarded;
                    - w/ a preop Hgb level of less than 11 g/dl about 93-96% of patients required a transfusion vs. only 52-59% of patients w/ a preop Hgb
                               of greater than 14 g/dl;
                    - w/ THR, expected transfusion requirements are 0.8 units when the Hgb level is more than 14 g/dl vs 1.6 units when Hgb level is less than 11 g/dl;
            - in the prospective randomized study by DB Billote MD et al (JBJS- Am Aug 2002, p 1299), the authors noted that preop autologous donation provided
                    no benefit for nonanemic patients undergoing primary total hip replacement;
                    - preoperative autologous donation increased the likelihood of autolgous transfusion, wastage of predonated units, and costs;
            - references:
                    - Preoperative Autologous Donation for Total Joint Arthroplasty. An Analysis of Risk Factors for Allogenic Transfusion
                             Hatzidakis AM, et al. J Bone Joint Surg Am. 2000;82(1):89.
    - aprotinin:
    - cell saver:
            - references:
                    - Use of recombinant human erythropoietin (r-HuEPO) in a Jehovah's Witness refusing transfusion of blood products: case report.
                    - Reinfusion of whole blood after revision surgery for infected total hip and knee arthroplasties.
                    - Methylmethacrylate monomer and fat content in shed blood after total joint arthroplasty.
                    - Unwashed Filtered Shed Blood Collected After Knee and Hip Arthroplasties: A Source of Autologous Red Blood Cells.
                    - Postoperative Blood Salvage Using the Cell Saver after Total Joint Arthroplasty.
                    - Reinfusion of shed blood after orthopaedic procedures in children and adolescents.
                    - Blood salvage after total hip arthroplasty.

- Transfusion Complications:
    - transfusion related infectious complications:

Outcome of massive transfusion exceeding two blood volumes in trauma and emergency surgery.

Perioperative blood transfusions are associated with increased rates of recurrence and decreased survival in patients w/ high-grade soft-tissue sarcomas of extremities.