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Overview :
Wong et al used a protocol to reduce the need for blood
transfusion in a patient undergoing total hip joint arthroplasty. This can
significantly reduce exposure of the patient to blood products but especially
allogeneic blood products. The authors are from the University of Western
Ontario, the University of Toronto and St. Michael's Hospital in Toronto,
Canada.
Parameters:
(1) preoperative hemoglobin
(2) number of weeks to surgery
|
Hemoglobin |
Weeks to
Surgery |
Recommended
Response |
|
<= 10 g/dL |
NA |
consider delaying surgery |
|
10 to 13 g/dL |
>= 4 weeks |
start iron; EPO 40,000 units per week x4 |
|
|
3 weeks |
start iron; EPO 40,000 units per week x3 |
|
|
2 weeks |
start iron; EPO 40,000 units per week x2 |
|
|
< 2 weeks |
start iron |
|
13.1 to 15 g/dL |
>= 4 weeks |
start iron; collect 2 units autologous RBCs |
|
|
3 weeks |
start iron; collect 2 units autologous RBCs |
|
|
2 weeks |
start iron; collect 1 unit autologous RBCs |
|
|
< 2 weeks |
start iron |
|
> 15 g/dL |
|
usually none required |
where:
• A patient
with significant anemia should have the cause identified and corrected prior to
surgery.
• Iron is
usually given orally. Iron may not be necessary for a patient with a condition
associated with iron overload.
• EPO =
erytrhopoietin or similar agent, injected once per week.
•
Erythropoietin has a lag period before maximal effect, which makes it of limited
use for handling an acute blood loss.
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