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

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