The use of autologous blood to improve exercise capacity after total hip arthroplasty: a preliminary report

• Published in: Transfusion (Philadelphia, Pa.) Pa.), 2006-09, Vol.46 (9), p.1484-1490
• Main Authors: Pilot, Peter, Bols, Esther M.J., Verburg, Aart D., Bell, Constant A.M.P., Moonen, Adrianus F.C.M., Van Os, Johannes J., Koolen, Jacques J., Geesink, Ruud G.T., Kuipers, Harm
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arthroplasty, Replacement, Hip; Biological and medical sciences; Blood Loss, Surgical; Blood Transfusion, Autologous; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Body Mass Index; Case-Control Studies; Cohort Studies; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Erythropoietin - administration & dosage; Erythropoietin - therapeutic use; Exercise Test; Female; Hemoglobins - analysis; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Orthopedic surgery; Oxygen Consumption; Physical Fitness; Pilot Projects; Postoperative Period; Preoperative Care; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/j.1537-2995.2006.00932.x

BACKGROUND: Venesection of red blood cells in healthy well‐trained subjects decreased the maximum oxygen uptake parallel with the reduction in hemoglobin (Hb) level. Based on the large Hb decrease that is seen after total joint surgery, one could expect a decrease in performance as well. The purpose of this study was to investigate whether autologous blood enhanced performance on a bicycle ergometer in patients after total hip arthroplasty. STUDY DESIGN AND METHODS: Nine patients scheduled for elective total hip arthroplasty in an accelerated stay program participated in a preoperative autologous blood donation (PABD) program. Weeks before the scheduled surgery, patients donated 4 units of blood and received standard erythropoietin treatment. Physical fitness was assessed during exercise test on a bicycle ergometer. Each patient was matched with three previously tested patients. RESULTS: Patients in both groups were 69.0 years old (range, 66‐74 years vs. 61‐77 years). None of the patients had relevant cardiovascular abnormalities. On average patients received 3.3 units of blood because 3 units were not transfused. The PABD group showed a Hb decrease of 0.5 g per dL (4%) on the fourth postoperative day versus 4.4 g per dL (31%) in the control group. The decline in power output on Day 4 was significantly less in the PABD group compared with the control group (t test, p = 0.026). CONCLUSION: From this pilot study it can be concluded that correction of the postoperative Hb decrease was associated with a lower decrease in maximum power output, compared to the control group. On Days 23 and 39, however, the difference in performance between the PABD group and control group had disappeared.