Grosflam et al identified factors which can be used to identify a patient who is more likely to lose blood during an elective total hip replacement. These can help identify a patient who may wish to donate additional units of autologous blood. The authors are from Brigham and Women's Hospital in Boston.


Patient selection:

(1) elective cases >= 16 years of age

(2) exclusions: HIV, transplant, chemotherapy, metastatic cancer, major surgery within previous 6 weeks

(3) while not an exclusion criterion, no patients were ASA classes IV or V


The mean blood loss was 3.6 units, with the mean blood replacement 2 units. Blood loss was estimated by the difference in pre and postoperative hematocrits (divided by 3) and the total number of units transfused.


Risk factors for increased blood loss:

(1) male gender

(2) ASA class III

(3) general anesthesia



• Comorbid conditions other than hypertension were infrequent.

• The method for estimating blood loss is subject to hemodilution from crystalloid infusion during surgery.

• Some surgeries were performed by residents and fellows in training, which was controlled for.

• Most of the replacements were done for osteoarthritis (71%) or rheumatoid arthritis (17%).

• 60% of the patients had the procedure done under local anesthesia only. 16% had general only and 24% had local plus general anesthesia (Table 2, page 169).


To read more or access our algorithms and calculators, please log in or register.