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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 8, 1079-1083.
doi: 10.1302/0301-620X.90B8.20595  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Pre-operative injections of epoetin-{alpha} versus post-operative retransfusion of autologous shed blood in total hip and knee replacement

A PROSPECTIVE RANDOMISED CLINICAL TRIAL

A. F. C. M. Moonen, MD, Resident Orthopaedic Surgeon1; B. J. W. Thomassen, Research Fellow1; N. T. Knoors, Trial Nurse1; J. J. van Os, MD, Orthopaedic Surgeon1; A. D. Verburg, MD, PhD, Orthopaedic Surgeon1; and P. Pilot, PhD, Senior Scientist2

1 Department of Orthopaedic Surgery, Maasland Hospital, PO Box 5500, 6130 MB, Sittard, The Netherlands.
2 Department of Orthopaedic Surgery, Reinier de Graaf Hospital, PO Box 5011, 2600 GA, Delft, The Netherlands.

Correspondence should be sent to Dr A. F. C. M. Moonen; e-mail: sjorsmoonen{at}hotmail.com

This prospective randomised clinical trial evaluated the effect of alternatives for allogeneic blood transfusions after total hip replacement and total knee replacement in patients with pre-operative haemoglobin levels between 10.0 g/dl and 13.0 g/dl. A total of 100 patients were randomly allocated to the Eprex (pre-operative injections of epoetin) or Bellovac groups (post-operative retransfusion of shed blood). Allogeneic blood transfusions were administered according to hospital policy.

In the Eprex group, 4% of the patients (two patients) received at least one allogeneic blood transfusion. In the Bellovac group, where a mean 216 ml (0 to 700) shed blood was retransfused, 28% (14 patients) required the allogeneic transfusion (p = 0.002). When comparing Eprex with Bellovac in total hip replacement, the percentages were 7% (two of 30 patients) and 30% (nine of 30 patients) (p = 0.047) respectively, whereas in total knee replacement, the percentages were 0% (0 of 20 patients) and 25% (five of 20 patients) respectively (p = 0.042).

Pre-operative epoetin injections are more effective but more costly in reducing the need for allogeneic blood transfusions in mildly anaemic patients than post-operative retransfusion of autologous blood.




eLetters:

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Is epoetin really a viable option?
Lydia K Milnes, et al.
J Bone Joint Surg Br Online, 14 Aug 2008 [Full text]

(c) British Editorial Society of Bone and Joint Surgery All Rights Reserved
Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General