Patient blood management in orthopedic surgery

Abstract

Arthroplasty improves the quality of life of patients with end-stage joint degeneration of the lower extremities, and the number of these operations is growing steadily. Hip and knee replacement is accompanied by advanced blood loss and high incidence of postoperative anemia and blood transfusion. Anemia and allogeneic blood transfusion increase postoperative morbidity and mortal-ity. Patient blood management (PBM) is an evidence-based, multidisciplinary, multimodal approach aimed at optimization of the treatment of patients who potentially need for allogeneic transfusion. This approach is able to minimize the need for donor blood products and prevent anemia. Researches devoted to the effectiveness of PBM components in orthopedic surgery are analyzed in this review. Diagnosis and treatment of preoperative anemia, perioperative administration of tranexamic acid and intravenous iron drugs and restrictive approach to transfusion are shown to be effective for reduction of the incidence of anemia and allogenic transfusions. Erythropoietin and autotransfusion are not suitable for routine application, but these measures may be useful in some cases. The impact of many methods on the outcomes requires further studies.