An extremely large group of patients having bilateral knee arthroplasty has been studied. Without blood conservation measures, 98% required allogeneic transfusion! This study shows the somewhat limited benefits of predonation (a 2 unit donation reduced the rate to 51%). Addition of a cell saver showed significant benefit,i.e. only 8% allogeneic transfusion. Trying to untangle the effects of multiple and/or combined modalities is difficult but the importance of using all the available options is clear.

– Peter Earnshaw