The Journal of Bone and Joint Surgery, Vol 73, Issue 8 1169-1178, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
Unwashed filtered shed blood collected after knee and hip arthroplasties. A source of autologous red blood cells
PM Faris, MA Ritter, EM Keating and CR Valeri
Center for Hip and Knee Surgery, Mooresville, Indiana 46158.
We evaluated the results of twelve hematological and plasma protein
determinations in 450 to 500-milliliter volumes of shed blood that had been
collected with or without acid-citrate-dextrose anticoagulant (National
Institutes of Health Formula A) from knees and hips during the first twelve
hours after arthroplasty. We also evaluated the effects on the recipients
when the blood was used for reinfusion. The findings in the units that had
been obtained in less than four hours, in between four and six hours, and
in more than six hours after the arthroplasty were similar whether or not
the acid-citrate-dextrose anticoagulant had been used. The mean values for
the collected units were: in the blood, a concentration of hemoglobin of
115 grams per liter, a hematocrit of 0.34, a white blood-cell count of 4.8
x 10(9) per liter, and a red blood-cell count of 3.7 x 10(12) per liter,
and, in the plasma, a level of hemoglobin of 160 grams per liter, a level
of fibrinogen of less than 0.2 gram per liter, a level of factor-V clotting
protein of less than 10 per cent of normal, a level of factor-VIII clotting
protein that was 45 per cent of normal, a level of antithrombin III that
was 45 per cent of normal, a level of plasminogen that was 55 per cent of
normal, a level of protein C that was 100 per cent of normal, and a level
of fibrin-degradation products of 1000 micrograms per milliliter of plasma.
The clinical response of the patient was assessed after the reinfusion of a
total of 205 units of unwashed shed blood into 153 patients. In addition,
in 126 of the 153 patients, hematological and plasma-protein measurements
were analyzed before the autotransfusion and one and twenty-four hours
afterward. Each of these patients had received one to four units of shed
blood that had been filtered but not washed. Only two (2 per cent) of the
ninety-nine patients who received shed blood that had been collected six
hours or less after the operation had a febrile reaction, whereas twelve
(22 per cent) of the fifty-four patients who received blood that had been
collected six to twelve hours after the operation had such a
reaction.(ABSTRACT TRUNCATED AT 400 WORDS)
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