Can anyone provide a current reference or two on the value of pre-deposit autologous donation for joint replacement surgeries? I think the benefits are no longer considered to be as high as previously thought but I need a reference on it.

I think that this is a good article, based on the abstract: Transfus Med. 2006 Oct;16(5):313-9

Bern MM, Bierbaum BE, Katz JN, Losina E.

Department of Medicine, New England Baptist Hospital, Boston, MA, USA. Murraybern@AOL.com

Autologous blood donation is designed to avoid complications from allogeneic blood, leaving units of blood in the general blood supply. It is unclear how efficient these programmes are in accomplishing these goals. It is unclear if autologous donation provokes increased need for any transfusion following surgery and whether it can be avoided in low-risk surgeries. Of 430 patients undergoing unilateral primary knee replacement arthroplasty over 12 months in our hospital, 309 had autologous donations and 121 did not. Of the 121 patients who did not donate, 36% completed surgery without transfusion, whereas only 17% of those who had autologous donations did so (P < 0.05). Age less than 65 years, higher baseline and postoperative haemoglobin levels were associated with lower transfusion rates. Patients who had autologous donations were approximately four times more likely to be transfused. As the number of autologous units donated increased, transfusions following surgery increased. Autologous donation did reduce allogeneic blood transfusions. Therefore, autologous blood donation for unilateral total knee arthroplasty is associated with overall increased transfusion rates, but with reduced need for allogeneic blood, independent of other clinical factors associated with transfusion. Therefore, there is need for reconsideration of these programmes relative to specific surgeries.

In doing a search, I thought that it would be good to find an article that was in a journal on orthopedic surgery...but most articles that I found recommended autologous donation to decrease the risk of allogeneic transfusion. The article above addresses the other side -- yes, you may be reducing the incidence of allogeneic transfusion, but are you increasing the risk of transfusion overall? Even autologous donation/transfusion is not without risk.

Heather -

Thanks for the interesting article info. Our Ortho surgeons used to routinely request their joint replacement patients to donate 2 autologous unit prior to surgery (and one of the surgeons often requested 4 autologous units to be donated!) Then one day one of the "2-units" surgeons must have done a little bit of a retrospective review and he came to the conclusion, "Gee, my patients who donated autologous units usually end up needing one or both units transfused back to them, but my patients who decide not to donate autologous units almost never need a transfusion!" (Golly, imagine that!!)

Now we rarely have a joint replacement patient donate autologous units. (And the "4-unit" surgeon has moved on to greener pastures.)