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Published on January 18, 2017

Replacing your knee without having to replace your bloodReplacing your knee without having to replace your blood

While the thought of getting your own blood transfused back into your body following knee replacement surgery may give you pause, it can be healthier for you.

Think of it as recycling.

A study published in the Journal of Orthopaedic Surgery and Research in 2015 noted that between 21 and 70 percent of patients having hip or knee replacements require blood transfusions due to blood loss during the surgery. The same study showed that the median estimated blood loss of the knee replacement patients was 790 milliliters, just under two pints or about 4 cups of coffee.

While allogeneic transfusions (blood donated by another person) are a safe choice for you and most patients never have a reaction according to the Centers for Disease Control and Prevention (CDC), fever and chills or allergic reactions are possible.

But there is another option: blood conservation, also known as blood salvaging. Blood you lose during your surgery is collected and returned to you after surgery.

There are several advantages to blood conservation during surgery, including reducing the need for a transfusion using someone else’s blood and preventing anemia. The option is also more cost effective for the patient.

“There are three major categories of blood salvaging,” said Robert Wilsterman, MD, an orthopedic surgeon at Falmouth Hospital.

“One is autologous, the second is cell save, and third is using a transfusion drain, which I use,” Dr. Wilsterman explained.

  1. Autologous blood donation involves donating one or two pints of your own blood two to three weeks before your knee replacement surgery. This is an expensive and time-consuming process because the blood has to be collected at a blood donation site, processed and stored until you need it.
  2. Cell save is done during surgery. It’s like the suction tube the dentist uses in your mouth during a dental procedure. A staff member assisting the surgeon will suction blood out of your surgical site while the orthopedic surgeon is working on your knee replacement. The blood passes through tubing into a sterile container and when enough blood is collected it will pass into the cell saver machine. Your red cells are filtered and washed with saline then passed into an IV bag for transfusion back to you.
  3. Transfusion drains are used to drain the blood from the joint after surgery to prevent your joint from getting congested with blood. A tube is inserted in the wound to drain blood into a sterile container. Once it is full or four hours have elapsed, the blood is passed through a series of filters into a transfusion bag and then back to you through an IV. If there is not more than 100 mls in the bag after four hours, the blood has to be thrown away.

While the transfusion drain can be used to save and re-infuse your blood back to you, there is another advantage to using it.

“The buildup of blood in the joint can be very painful, delay recovery and be a risk for infection,” said Dr. Wilsterman.

The blood that is drained from the joint used to be thrown away but with the advent of new sterile kits and system, the blood can be used to re-infuse back into the patient.

Blood salvaging is especially helpful to patients who have cultural or religious beliefs about receiving someone else’s blood, according to Dr. Wilsterman.

“It’s a small price to pay to ease the patient’s mind to know that you are doing everything you can to honor their wishes about their blood.”

A study published by the National Center for Biotechnology Information [pdf], in 2011 showed a dramatic reduction in the need for patients with knee replacements to receive allogeneic transfusions when transfusion drains were used.

Dr. Wilsterman also offers another technique to limit blood loss during surgery, which involves performing the procedure without a tourniquet.

“By not using a tourniquet, I deal with the bleeding as it happens,” he said. “By the time I complete the surgery, I’ve cauterized all the bleeders and while they lose a small amount of blood while I am cauterizing, it’s not significant.

“In those patients, I don’t routinely put drains in because their wounds are dry by the end of the case.

It’s the best of both worlds.”