Blood Management Strategies in Total Knee Arthroplasty

A critical component of successful patient care in total knee arthroplasty (TKA) is a blood management strategy. TKA can result in substantial perioperative blood loss, rendering patients at increased risk of requiring allogenic blood transfusion 1,2) . Total knee and hip arthroplasty and fracture surgery is the number one reason for transfusion in patients undergoing surgery and accounts for 9.8% of all transfused red blood cell units 3) . Complications of allogenic blood transfusion include the risk of disease transmission, hemolytic reaction, fluid and hemodynamic overload, acute lung injury, coagulopathy, allergic reaction and febrile non-hemolytic reaction 4) . Allogenic transfusion is associated with immunomodulation, and an increased incidence of prosthetic infection 5,6) . Bierbaum et al. 7) reported a transfusion rate of 39% following TKA, with an increased risk of fluid overload, infection rate and duration of hospitalization in the patients who received allogenic transfusion. Several studies have highlighted the disadvantages of allogenic blood including a negative effect on postoperative complications, length of hospital stay, cost and mortality [8][9]