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. 2024 Feb 8;14(1):3298.
doi: 10.1038/s41598-024-53779-6.

Effectiveness, safety and indications of acute normovolemic haemodilution in total knee arthroplasty

Yucong Li #  1 , Jingle Chen #  1 , Hao Xie #  1 , Hangxing Wu  1 , Zhijie Zuo  1 , Wanyan Hu  1 , Chao Xie  2 , Lijun Lin  3
Affiliations

Effectiveness, safety and indications of acute normovolemic haemodilution in total knee arthroplasty

Yucong Li et al. Sci Rep. .

Abstract

Total knee arthroplasty (TKA) is the most cost-effective, and potent method for the treatment of end-stage knee osteoarthritis. Acute normovolemic haemodilution (ANH) can effectively replace the need for allogeneic transfusions due to the high amount of bleeding during TKA. However, more studies are needed to prove the efficacy and safety of ANH and to clarify its indications in the field of knee replacement. Medical records from June 1, 2019 to June 1, 2021 were searched and grouped according to inclusion and exclusion criteria.

Part i: 58 patients with ANH during TKA were selected as the ANH group (n = 58), and 58 patients with allogeneic transfusion were chosen as the control group (n = 58).

Part ii: Patients with anaemia were divided into the ANH group (n = 18) and the control group (n = 12).

Part i: The postoperative inflammatory index and serum albumin in the ANH group were significantly lower than those in the control group. No significant difference was observed in the theoretical loss of red blood cells, postoperative renal function, liver function, cardiac function and biochemical ion index between the two groups. The effective rate of ANH in the normal haemoglobin group was significantly lower than that in the anaemia group.

Part ii: In patients with anaemia, the theoretical loss of red blood cells in patients with ANH was less than that in the control group. The postoperative inflammation, renal function, liver function and cardiac function in the ANH group were better than those in the control group, and no significant difference was noted in biochemical ions and nutritional status indicators. This paper shows that ANH not only can replace allogeneic transfusion in TKA, especially in patients with anaemia, but also has lower inflammatory indicators than allogeneic transfusion. From a security perspective, the body's tolerance to ANH is within the body's compensation range.

Keywords: Acute normovolemic haemodilution; Indications; Perioperative blood management; Total knee arthroplasty.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Screening process. (A) Screening out ANH and allogeneic transfusion medical records according to inclusion and exclusion criteria. (B) Screening out anemia medical records.
Figure 2
Figure 2
The effectiveness of ANH in TKA. (A,B) ANH have the same perioperative hematological indexes as allogeneic transfusion. (C–F) ANH have the lower perioperative inflammatory indexes than allogeneic transfusion (*P < 0.05).
Figure 3
Figure 3
The effectiveness of ANH in TKA of anemia patients. (A) ANH have the better perioperative hematological indexes than allogeneic transfusion. (B–D) ANH have the lower perioperative inflammatory indexes than allogeneic transfusion. (*P < 0.05).
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