Published online Jun 18, 2017. doi: 10.5312/wjo.v8.i6.441
Peer-review started: February 3, 2017
First decision: March 8, 2017
Revised: March 20, 2017
Accepted: April 6, 2017
Article in press: April 10, 2017
Published online: June 18, 2017
Total knee replacement (TKR) is one of the most common surgeries over the last decade. Patients undergoing TKR are at high risk for postoperative anemia and furthermore for allogeneic blood transfusions (ABT). Complications associated with ABT including chills, rigor, fever, dyspnea, light-headedness should be early recognized in order to lead to a better prognosis. Therefore, perioperative blood management program should be adopted with main aim to reduce the risk of blood transfusion while maximizing hemoglobin simultaneously. Many blood conservation strategies have been attempted including preoperative autologous blood donation, acute normovolemic haemodilution, autologous blood transfusion, intraoperative cell saver, drain clamping, pneumatic tourniquet application, and the use of tranexamic acid. For practical and clinical reasons we will try to classify these strategies in three main stages/pillars: Pre-operative optimization, intra-operative and post-operative protocols. The aim of this work is review the strategies currently in use and reports our experience regarding the perioperative blood management strategies in TKR.
Core tip: Total knee replacement is one of the most common elective surgeries in orthopaedics. Blood loss during surgery is putting the patient at risk for a blood transfusion. A number of reviews and meta-analyses have tried to analyze the best blood conservation strategy. Our objective is to review any blood saving method/strategy into the preoperative, intraoperative and postoperative period and analyze their possible combination. A zero allogenic blood transfusion rate with safe and cost-effective methods should be the aim and an achievable goal.