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St.Vincent Greatly Reduces Need for Blood for Joint Patients Due to the risks associated with blood transfusions as well as a shortage in blood supplies, St.Vincent has been developing blood conservation techniques for years. Individuals who have total hip or knee replacements may sometimes experience substantial blood loss. However, surgeons with the St.Vincent Center for Joint Replacement have developed a very successful strategy for blood conservation that has produced excellent patient results.
A blood conservation protocol developed by Dr. Jeffery L. Pierson, medical director for the Center, has been shown to dramatically reduce the need for blood transfusions. In a recent study of 500 patients, Dr. Pierson reported that of the patients who followed his protocol, only 2 percent needed a transfusion, compared with national rates of over 20 percent.
A reduction in the need for blood transfusions:
- Reduces the potential for transmitting diseases
- Reduces costs
- Helps with the problem of declining blood supplies
- May reduce the risk of Infection
- Reduces the likelihood of allergic reactions
Since the 1980s, the most common strategy for conserving blood in total joint replacement patients was the use of predonated blood. Predonation of “autologous blood” is the practice of having patients donate their own blood before surgery. This often requires several trips for sufficient volume of blood to be collected.
However, this predonation of blood:
- Is inconvenient
- Is wasteful
- Is costly
- Is likely to cause anemia
- May make a transfusion more likely to be necessary after surgery
St.Vincent generally discourages donating blood before surgery, for the previously noted reasons. Patients who predonate blood have significantly higher transfusion rates than those who follow the conservation strategy.
As part of the protocol, surgeons assess each patient’s projected hemoglobin levels and projected blood loss during surgery. Expected blood loss is reasonably predictable. A low hemoglobin level (the capacity of the blood to carry oxygen) shows the patient may be anemic or at risk for becoming anemic.
If a patient is anemic before surgery and is at high risk for a transfusion, the patient may be given a drug called Epoetin alpha. This drug stimulates the patient’s bone marrow to produce red blood cells. The increase in red blood cells causes the hemoglobin levels to increase. Once the hemoglobin levels are back to normal, the transfusion risk is substantially reduced. In fact, in our study, none of the patients who received the drug before surgery required a transfusion.
In summary, the St.Vincent blood conservation program involves:
- Discouraging predonation of blood
- Selective use to Epoetin alpha for anemic patients at risk for transfusion
- Specific criteria to determine if a transfusion is necessary
The remarkable conservation program has sharply reduced the need to rely on available blood supplies, while also reducing the risks of transfusions.
For more information on our blood conservation strategy for joint patients, contact us via email or call (800) 338-BONE (2663). | 
