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Protocol of Wong et al for Reducing Allogeneic Blood Transfusion in a Patient Undergoing an Elective Total Hip Arthroplasty

Description

Wong et al used a protocol to reduce the need for blood transfusion in a patient undergoing total hip joint arthroplasty. This can significantly reduce exposure of the patient to blood products but especially allogeneic blood products. The authors are from the University of Western Ontario, the University of Toronto and St. Michael's Hospital in Toronto, Canada.


 

Parameters:

(1) preoperative hemoglobin

(2) number of weeks to surgery

Hemoglobin

Weeks to Surgery

Recommended Response

<= 10 g/dL

NA

consider delaying surgery

10 to 13 g/dL

>= 4 weeks

start iron; EPO 40,000 units per week x4

 

3 weeks

start iron; EPO 40,000 units per week x3

 

2 weeks

start iron; EPO 40,000 units per week x2

 

< 2 weeks

start iron

13.1 to 15 g/dL

>= 4 weeks

start iron; collect 2 units autologous RBCs

 

3 weeks

start iron; collect 2 units autologous RBCs

 

2 weeks

start iron; collect 1 unit autologous RBCs

 

< 2 weeks

start iron

> 15 g/dL

 

usually none required

 

where:

• A patient with significant anemia should have the cause identified and corrected prior to surgery.

• Iron is usually given orally. Iron may not be necessary for a patient with a condition associated with iron overload.

• EPO = erythropoietin or similar agent, injected once per week.

• Erythropoietin has a lag period before maximal effect, which makes it of limited use for handling an acute blood loss.

 


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