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Blood management after bilateral total knee arthroplasty.

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 […]

US NAT yield: where are we after 2 years?

Discussion of very recent literature, calculation of current risk of transfusion transmitted viral infections after introduction of NAT-HCV and NAT-HIV. Determination of cost/benefit of introduction of NAT. Conclusive statement that p24 antigen testing should be omitted after introducztion of NAT. – Volker Kretschmer

Hydroxyethyl starch (HES) 130/0.4 provides larger and faster increases in tissue oxygen tension in comparison with prehemodilution values than HES 70/0.5 or HES 200/0.5 in volunteers undergoing acute normovolemic hemodilution.

This prospective randomized double-blinded crossover study demonstrated that hydroxyethyl starch specifications (in vitro molecular weight, degree and pattern of substitution) could significantly alter muscular tissue oxygen tension used as an indicator of blood rheology. The better results obtained with HES 130/0.4 might be attributed to the optimum “in vivo” molecular size achieved by this hydroxyethyl […]

The use of acute normovolemic hemodilution in patients undergoing cardiac surgery.

In this observational study, the authors report their experience with the use of acute normovolemic hemodilution in cardiac surgery patients. – Philippe Van der Linden This article convincingly shows that ANH in patients undergoing cardiac surgery significantly reduces the need for allogeneic blood transfusion. Autologous blood removed ranged from 1 (70%) to 2-5 (30% of […]

A mathematical model of cell salvage efficiency.

In this excellent paper, the authors develop a mathematical model that may help our understanding of the efficiency of blood salvage. The basic insights from these theoretical considerations are that we should make all efforts to increase RBC recovery from the surgical field and use smaller bowls for low-weight and low-hematocrit patients. Difficulties in translating […]

Identifying patients for blood conservation strategies.

This retrospective study nicely demonstrates that the use of a simple algorithm taking into account the type of operation and the preoperative hemoglobin concentration can be effective in identifying patients likely to require perioperative allogeneic blood transfusion. – P. Van der Linden Although no clear transfusion trigger was used, the algorithm allows a significant reduction […]