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Overview :
Aderinto and Brenkel identified preoperative factors
associated with the need for blood transfusion after a unilateral total hip
replacement. The authors are from Queen Margaret Hospital in Dunfermline,
Scotland.
Risk factors identified on multivariate analysis:
(1) preoperative
hemoglobin < 12 g/dL (a mild increase is seen with hemoglobin in the 12-12.9
g/dL range)
(2) body weight
< 70 kilograms
Parameters covered by these 2 risk factors:
(1) female gender
(2) older age
(3) lower height and body mass index (BMI)
Additional factors affecting blood transfusion:
(1) bilateral
surgery (vs unilateral replacement)
(2)
availability of autologous units (a factor seen in the previous section on
spinal fusion surgery)
By restricting type and crossmatch to patients with a
preoperative hemoglobin < 11 g/dL the number of units crossmatched could be
reduced by 78%.
For the implementation I will recommend type and crossmatch
if the preoperative hemoglobin is < 12 g/dL or (hemoglobin < 13 g/dL AND
weight < 70 kg), else type and screen.
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