The utilization of autologous and allogeneic transfusions in total joint arthroplasties was to characterize patients who may benefit from giving preoperative blood donations. We conducted a retrospective chart review of 525 patients to document preoperative hematocrit, estimated blood loss, length of stay, transfusions, and medical comorbidities. Results of our review showed that total hip arthroplasty revision (THA-R) had the highest prevalence of transfusions (60%) followed by total hip arthroplasty (THA, 53%), total knee arthroplasty-revision (TKA-R, 33%), and total knee arthroplasty (TKA, 23%). There was significant waste of autologous donations: 92% of TKA patients, 64% of THA, and 33% of THA-R patients wasted on average 1.527, 1.321, and 1.5 autologous units, respectively. Pre-operative hematocrit was the strongest predictor of future transfusion need across all procedures, and primary THA had additional predictors in age and gender. 1. Introduction Anemia is a significant and frequent complication of total joint replacements. Anemia after total joint replacement has been shown to increase length of stay, decrease immediate postoperative physical function, and increase the likelihood of requiring a blood transfusion [1]. Allogeneic blood transfusion, while important in treating anemia, are not without risks and have been shown to lead to immunosuppression, blood-borne disease transmission, immunologic reactions, allergic reactions, and increased mortality [1–3]. Developing strategies to treat or prevent postoperative anemia while limiting the exposure of patients to allogeneic blood has become an important focus. Multiple studies have found that low preoperative hemoglobin is a major risk factor for perioperative and postoperative transfusion after total joint arthroplasty [4–7]. Attempts to improve preoperative hematocrit, including iron therapy and erythropoietin stimulating agents, have been inconsistent in demonstrating a significant effect on preoperative hematocrit [8]. Additional strategies have included perioperative blood salvage (i.e., cell saver), hemodilution, and preoperative donation of blood for autologous transfusion [9–12]. Using autologous donations for transfusion avoids many of the adverse events associated with allogeneic transfusion as noted above [2, 13]. Autologous donations, if utilized effectively, decrease the cost of obtaining, storing, and using allogeneic blood [14–16]. In practice, however, obtaining preoperative autologous donations is often time consuming, expensive, and inefficient. Additionally, many patients who
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