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Review
. 2017 Jun 18;8(6):441-454.
doi: 10.5312/wjo.v8.i6.441.

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

Tzatzairis Themistoklis  1 , Vogiatzaki Theodosia  1 , Kazakos Konstantinos  1 , Drosos I Georgios  1
Affiliations
Review

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

Tzatzairis Themistoklis et al. World J Orthop. .

Abstract

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.

Keywords: Anaemia; Autologous blood donation; Blood loss; Blood management; Haemodilution; Perioperative; Total knee arthroplasty; Total knee replacement; Tourniquet; Tranexamic acid; Transfusion; Transfusion protocol.

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Conflict of interest statement

Conflict-of-interest statement: No potential conflicts of interest. No financial support.

Figures

Figure 1
Figure 1
Algorithm proposed for low hemoglobin investigation. Hb: Hemoglobin.
Figure 2
Figure 2
Algorithm used in our department regarding the allogeneic blood transfusion strategy. Hb: Hemoglobin.
See this image and copyright information in PMC

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