Original Research
Hemolysis and Survival of Autologous Red Blood Cells Salvaged After Cemented and Uncemented Total Hip Arthroplasty
Am J Orthop. 2010 February;39(2):76-79
Author and Disclosure Information
Branko Tripkovic, MD, PhD, Katarina Sakic, MD, PhD, Sanja Jakovina, MD, Šime Šakic, MD, PhD, and Zlatko Hrgovic, MD, PhD
Dr. Tripkovic is Medical Doctor and Anesthesiologist, Orthopaedic Surgery Department, University Hospital Zagreb, Zagreb, Croatia.
Dr. Sakic is Assistant Professor of Anesthesiology, University Hospital Dubrava, Zagreb, Croatia.
Dr. Jakovina is Medical Doctor and Anesthesiologist, and Dr. Šakic is Associate Professor of Orthopedics, Orthopaedic Surgery Department, University Hospital Zagreb, Zagreb, Croatia.
Dr. Hrgovic is Medical Doctor and Professor, Medical School of Frankfurt, J. W. Goethe University, Frankfurt, Germany.
Autotransfusion is widely used after total hip arthroplasty (THA), but there are concerns about damage of red blood cells (RBCs) collected after surgery. In this study, we wanted to determine the damage and survival of RBCs salvaged after cemented THA and after uncemented THA and to compare the results.
In this prospective study of 60 patients—30 who underwent cemented THA and 30 who underwent uncemented THA—postoperative autotransfusion systems (BIODREN; B.E.R.C.O., Modena, Italy) were used. Levels of potassium and free hemoglobin in the postoperative blood samples were analyzed. Before transfusion, salvaged RBCs were labeled with radioactive chromium-51, and their survival was measured.
In blood salvaged after cemented THA, medium potassium level was 4.1 mmol/L (range, 3.2-5.6 mmol/L), and mean free hemoglobin level was 327 mg% (range, 120-410 mg%). In blood salvaged after uncemented THA, mean potassium level was 4.2 mmol/L (range, 3.1-5.5 mmol/L), and mean free hemoglobin level was 296 mg% (range, 130-402 mg%). In the cemented group, RBC survival was 73% at 48 hours after transfusion (range, 61%-79%), and mean time from 100% activity to 50% activity was 21 days (range, 14.2-28.2 days). In the uncemented group, RBC survival was 75% at 48 hours after transfusion (range, 68%-82%), and mean time from 100% to 50% activity of radio-labeled RBCs was 22 days (range, 16.2-29.4 days).
There were no statistically significant differences in potassium levels, free hemoglobin levels, or RBC survival between the cemented and uncemented groups. Blood salvaged after surgery was not significantly damaged. Our study results confirmed that washing blood collected after surgery is not necessary. Not washing this blood is safe and decreases allogeneic transfusion in orthopedic procedures.