Evren Fehmi ATAY, Melih GÜVEN, Faik ALTINTAŞ, Barış KADIOĞLU, Emrah CEVİZ, Serdar İPEK

Kalça ve diz artroplastisinde ameliyat sonrası ototransfüzyon allojenik kan transfüzyonunu azaltır

Amaç: Bu çal›flmada kalça ve diz artroplastisinde ameliyat sonras› uygulanan ototransfüzyon yönteminin allojenik kan transfüzyonu ihtiyac›n› önlemedeki etkinli¤inin de¤erlendirilmesi amaçlanm›flt›r. Çal›flma plan›: Total kalça ve diz artroplastisi uygulanm›fl 74 hasta (77 artroplasti giriflimi) ça- l›flma ve kontrol gruplar›na randomize edilerek prospektif olarak de¤erlendirildi. Diz grubunda (39 hasta; 30 kad›n, 9 erkek; ortalama yafl 66.6) standart yaklafl›mla turnike kontrolünde çimen- tolu, kalça grubundaysa (35 hasta; 24 kad›n, 11 erkek; ortalama yafl 59.3) posterolateral yakla- fl›mla çimentosuz artroplasti uyguland›. Hiçbir hastaya ameliyat öncesinde ve s›ras›nda allojenik kan transfüzyonu yap›lmad›. Çal›flma gruplar›ndaki hastalarda ameliyat sonras› 4. saatte cerrahi sahada biriken kan ototransfüzyon seti ile transfüze edildi. Kalça ve diz çal›flma gruplar›nda or- talama ototransfüzyon miktarlar› s›ras›yla 413 mL ve 480 mL idi. Banka kan› transfüzyonu; he- moglobin 8 gr/dL’nin, hematokrit ise %25’in alt›nda oldu¤u ve klinik olarak anemi bulgular›n›n efllik etti¤i hastalarda uyguland›. Sonuçlar: Çal›flma ve kontrol gruplar› aras›nda ameliyat öncesi ve sonras› hemoglobin-hematok- rit de¤erlerinde istatistiksel anlaml› fark yoktu. Diz hastalar›nda çal›flma grubunda 1 (%5), kon- trol grubunda 8 (%38) (p=0.01); kalça hastalar›nda ise çal›flma grubunda 9 (%53), kontrol gru- bunda 15 (%79) hastada (p=0.044) banka kan› transfüzyonu yap›ld›. Çal›flma gruplar›nda alloje- nik transfüzyon miktar› kontrol gruplar›na göre anlaml› olarak düflüktü (diz grubu p=0.008, kal- ça grubu p=0.048). Ç›kar›mlar: Diz ve kalça artroplastisinde ototransfüzyon yöntemiyle diz artroplastisinde daha belirgin olmak üzere allojenik kan transfüzyonu ihtiyac› ve transfüzyon miktar› azalmaktad›r.

___

1. Lemos MJ, Healy WL. Blood transfusion in orthopaedic operations. J Bone Joint Surg Am 1996;78:1260-70.

2. Woolson ST, Watt JM. Use of autologous blood in total hip replacement. A comprehensive program. J Bone Joint Surg Am 1991;73:76-80.

3. Slagis SV, Benjamin JB, Volz RG, Giordano GF. Postoperative blood salvage in total hip and knee arthro- plasty. A randomised controlled trial. J Bone Joint Surg Br 1991;73:591-4.

4. Grosvenor D, Goyal V, Goodman S. Efficacy of postoper- ative blood salvage following total hip arthroplasty in patients with and without deposited autologous units. J Bone Joint Surg Am 2000;82-A:951-4.

5. Newman JH, Bowers M, Murphy J. The clinical advan- tages of autologous transfusion. A randomised, controlled study after knee replacement. J Bone Joint Surg Br 1997; 79:630-2.

6. Pola E, Papaleo P, Santoliquido A, Gasparini G, Aulisa L, De Santis E. Clinical factors associated with an increased risk of perioperative blood transfusion in nonanemic patients undergoing total hip arthroplasty. J Bone Joint Surg Am 2004;86-A:57-61.

7. Helm AT, Karski MT, Parsons SJ, Sampath JS, Bale RS. A strategy for reducing blood-transfusion requirements in elective orthopaedic surgery. Audit of an algorithm for arthroplasty of the lower limb. J Bone Joint Surg Br 2003; 85:484-9.

8. Bilgen ÖF, Y›lmaz Y. The effect of tourniquet use in total knee prosthesis. [Article in Turkish] Acta Orthop Traumatol Turc 2001;35:390-4.

9. Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 1999;81:2-10.

10. Aderinto J, Brenkel IJ. Pre-operative predictors of the requirement for blood transfusion following total hip replacement. J Bone Joint Surg Br 2004;86:970-3.

11. Rosencher N, Kerkkamp HE, Macheras G, Munuera LM, Menichella G, Barton DM, et al. Orthopaedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management of elective knee and hip arthro- plasty in Europe. Transfusion 2003;43:459-69.

12. Öztürk G, Bölükbafl› S, Ünsal T, Songür M. Allogeneic blood transfusion policy in orthopedic surgery. [Article in Turkish] Acta Orthop Traumatol Turc 2003;37:313-8.

13. Spence RK, Carson JA, Poses R, McCoy S, Pello M, Alexander J, et al. Elective surgery without transfusion: influence of preoperative hemoglobin level and blood loss on mortality. Am J Surg 1990;159:320-4.

14. Carson JL, Noveck H, Berlin JA, Gould SA. Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion 2002;42:812-8.

15. Hébert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999; 340:409-17.

16. Huo MH, Paly WP, Keggi KJ. Effect of preoperative autologous blood donation and intraoperative and postop- erative blood recovery on homologous blood transfusion requirement in cementless total hip replacement operation. J Am Coll Surg 1995;180:561-7.

17. Goodnough LT, Wasman J, Corlucci K, Chernosky A. Limitations to donating adequate autologous blood prior to elective orthopedic surgery. Arch Surg 1989;124:494-6.

18. Guerra JJ, Cuckler JM. Cost effectiveness of intraopera- tive autotransfusion in total hip arthroplasty surgery. Clin Orthop Relat Res 1995;(315):212-22.

19. Han CD, Shin DE. Postoperative blood salvage and rein- fusion after total joint arthroplasty. J Arthroplasty 1997;12:511-6.

20. Ayers DC, Murray DG, Duerr DM. Blood salvage after total hip arthroplasty. J Bone Joint Surg Am 1995;77: 1347-51.

21. Bottner F, Pavone V, Johnson T, Heitkemper S, Sculco TP. Blood management after bilateral total knee arthro- plasty. Clin Orthop Relat Res 2003;(410):254-61.