Blood Product Utilization in Hip and Knee Arthroplasty: Effect of Gender and Autologous Blood on Transfusion Practice

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Abstract
Analysis of total blood product support for a 1-year cohort of patients undergoing hip or knee total joint arthroplasty showed significant differences in transfusion therapy between patients who predeposited autologous blood and those who did not. In primary joint arthroplasty, 51% of nonpredepositing patients undergoing hip replacement and 28% of nonpredepositing patients undergoing knee replacement required red cell transfusions. In revision procedures, 58-61% were transfused. Predepositors requiring only autologous blood received less blood per patient than nonpredepositors; however, 73-87% of primary and 86-88% of revision arthroplasty patients were transfused. Predepositors receiving supplemental allogeneic blood used a volume of red cells comparable to nonpredepositing patients, which was significantly greater than the red cell requirement of predepositors using only autologous blood. Moreover, regardless of predeposit status, the extent of red cell replacement differed between men and women. Male patients presented with significantly higher hematocrits and were less likely to be transfused than females undergoing the same procedure. However, once the transfusion-decision was made, the average amount of red cells given for each procedure did not show gender-related variation. Despite differences in admission and lowest observed hematocrits, all patients were discharged with hematocrits in the same range, suggesting that men were replaced with relatively less blood than women. These differences in transfusion practice relating to gender and predeposit status could not be associated with identifiable changes in clinical outcome which might provide rationale for the observed differences in practice.