Blood Conservation in Orthopedic Trauma. Issue 1 (March 2017)

• Record Type: Journal Article
• Authors: Nayar, Suresh K.; Shafiq, Babar
• Is Part Of: Techniques in orthopaedics. Volume 32:Issue 1(2017)
• Publication Date: 2017-03
• Subjects: blood conservation -- cell salvage -- orthopedic trauma -- tranexamic acid -- transfusion; Orthopedics -- Periodicals; 617.47
• DOI: 10.1097/BTO.0000000000000208
• Languages: English
• ISSNs: 0885-9698

Abstract

Abstract : In the setting of acute orthopedic trauma, blood management strategies are reactive rather than anticipatory, and patients may not receive the same options offered in elective surgery. There are several strategies for conserving blood, but it is not feasible for the orthopedic traumatologist to be familiar with the complexities of each method. Instead, practical options and those routinely offered at trauma centers should be considered. Evidence supports tolerable transfusion thresholds of hemoglobin concentrations of 7 and 8 g/dL for patients with and without history of cardiac disease, respectively. Cell salvage reduces the need for transfusions and produces modest cost savings in cases with blood loss exceeding 500 mL. Although researchers are still investigating the efficacy of tranexamic acid in orthopedic trauma, other large randomized controlled trials in the setting of general trauma, as well as in arthroplasty and spine surgery, have shown significant reductions in blood loss without increased risk of venous thromboembolism. Currently, little evidence supports the use of autotransfusion devices and biological adhesives in orthopedic trauma. Erythropoietin aids in blood conservation, but at an unacceptably high cost. Intravenously administered iron may help patients recover from postoperative anemia. There are few large, rigorous studies of blood management in orthopedic trauma; therefore, expert opinion, logical deduction, and practical reasoning are necessary to determine appropriate strategies on a case-by-case basis.