MOORESVILLE, Ind. -- At many hospitals, most patients receive a blood transfusion after hip and knee replacement surgery. But should they?“While some blood loss is unavoidable after hip and knee replacement surgery, the need for a blood transfusion is rare in our experience,” said Jeff Pierson, M.D., orthopedic surgeon with the Center for Hip & Knee Surgery at St. Francis Hospital-Mooresville.
New techniques allow nearly all patients to undergo “bloodless” joint replacements — surgeries that do not require post-operative blood transfusions, Pierson said. Minimizing the risk of a blood transfusion requires identifying those patients who are at the highest risk of requiring a transfusion before surgery (typically women with anemia), using techniques to increase their hemoglobin (blood count) before surgery, and adopting evidence-based blood transfusion criteria after surgery.
“The benefits of a blood transfusion are remarkably poorly understood,” Pierson said. “In fact, a growing body of scientific evidence has shown that receiving a blood transfusion is usually more harmful than beneficial. Our patients rarely require a blood transfusion.”
In most circumstances, the risk of a blood transfusion outweigh any benefit, Pierson notes.
“Our work has demonstrated that only one or two patients out of 100 should require a blood transfusion after hip or knee replacement surgery. This is one of the lowest uses of blood transfusions in the world.”
Patients who receive no blood transfusions experience fewer infections and shorter hospital stays, according to recent studies.
"What we do before surgery greatly affects what happens after," Pierson said. "Patients going into surgery with normal blood counts have the best chance of avoiding post-operative transfusions. Therefore, we identify those patients who are at the greatest risk of needing a blood transfusion and optimize their hemoglobin before the surgery. This substantially lowers their risk of a blood transfusion.”
Most patients have a normal hemoglobin level and require no special intervention before their surgery. However, anemic patients may need to take iron and a medication that stimulates the bone marrow to make more red blood cells before their surgery.
“While it is emotionally appealing for patients to donate their own blood before surgery, we have not found this to be effective, and we discourage it,” Pierson said.
Donating your own blood before surgery lowers your hemoglobin (makes you anemic), and the storage of your blood before the surgery makes the blood less effective.
The Center’s surgeons are recognized as world leaders in reducing the risk of a blood transfusion after hip and knee replacement surgery.
“This is important to us because we know it is important to our patients,” Pierson said.
The Center for Hip and Knee Surgery is located at 1201 Hadley Road in Mooresville. Pierson also operates a practice at 12188-A N. Meridian St., Suite 325, Carmel.
To learn more about the Center for Hip & Knee Surgery, go to www.stfrancishospitals.org/Ortho.
