Patient Resources for Diseases & Surgeries:
Blood Loss Management
During every knee replacement surgery, there is a certain amount of blood loss. There are several approaches to address the management of this blood loss that you should discuss with your orthopaedic surgeon, including blood transfusions (self donated or donated by another individual) or Procrit® treatment.
Blood Transfusion
Many patients who have a knee replacement will require blood transfusion.This can be achieved by transfusing blood that you have donated prior to your surgery or by receiving blood from a donor.
Self Donation
If you are donating blood for your surgery, you will be asked to donate 1 to 2 units of your own blood within 35 days prior to your surgery date.This will involve scheduling an appointment with the blood bank of the hospital, or if necessary, a blood donation facility recommended by your insurance carrier or one closer to where you live (for out-of -state patients) Only one unit of blood can be donated at a time, so you may need to come in for two visits.The blood is then stored until your operation.If you're coming a long way, arrangements can be made to have you give blood locally and have it transported here for your surgery.Please be assured that blood that you give will be given back to you, if needed.
Donor Blood
If you are unable to donate blood, for whatever reason, donor blood may be used in your case, if necessary. Donor blood can be donated by family or friends and directed to you or it can be obtained from the national blood supply. People have expressed some concern about blood transfusion because of the risk of transmitting diseases. Donor blood is carefully screened for communicable diseases. With the new technology, the risk of hepatitis and HIV infection is extremely low. To our knowledge, disease transmission through use of donated blood has never occurred in any of our patients.However, there is no question that your own blood is the safest. Therefore, if you are able, we recommend that you donate blood for your surgery.
Procrit®
Another approach to blood loss management is to treat patients with Procrit® - a medication that works to increase the red blood cell supply before surgery. If you are a candidate for Procrit treatment, your blood will be tested to determine its hemoglobin (this is a measure of how much of your blood is made up of blood cells). If your hemoglobin is between 10 and 13 (g/dL), you can receive Procrit®treatment.This involves four injections (subcutaneous-under the skin) in once weekly doses (21, 14, and 4 days before surgery) plus a fourth dose on the day of surgery.You will be asked to take iron supplements during this time.
Blood Loss
Although the surgeon uses several standard techniques to control the amount of bleeding resulting from the surgical procedure, a certain amount of blood loss occurs with every case. Blood is made up of cells and the fluid that contains the cells. When you lose blood, there are fewer cells, and your hematocrit goes down. Red blood cells carry a substance called hemoglobin. Hemoglobin, which binds to iron, carries oxygen from the lungs to tissues. So if you experience blood loss, you may also have a decrease in your hemoglobin.
Why is this important?
Your body needs to maintain a certain level of oxygen within its tissues to function properly. Fatigue is a primary symptom of below-normal hemoglobin which may impact on your recovery after surgery. Other possible symptoms include weakness, dizziness, and shortness of breath. This is obviously not desirable when you are trying to recover from a major surgery like total knee or hip replacement.
What Can Be Done?
There are three standard approaches to managing blood loss - 1) receive blood that you have donated prior to your surgery, 2) receive blood from a donor, or 3) undergo PROCRIT therapy.
Blood Transfusion
You can receive a transfusion with your own blood (self donation) or with blood that has been donated by someone else.
Donating Your Own Blood
Donating your own blood (autodonation) refers to the collection of your blood before surgery for use during or after surgery. Using your blood decreases the chance of receiving donated blood, thus preventing exposure to infectious disease and transfusion reaction.
Patients are usually asked to donate one or more units of their blood over a period of time before their surgery. The amount of blood collected depends on the operation you are having, as well as your ability to donate. However, when you donate blood, your own red blood cell count (hemoglobin level) drops, so you are actually giving blood you need. Because it takes time for your body to replace the blood donated, you may not be able to donate your own blood if:
- Your surgery is within 2 weeks. Your body needs time to replace the red blood cells that you would have donated
- You have other illnesses (i.e., infections, certain cardiac conditions, or seizures that might weaken your body)
- Your blood pressure is abnormal
- You are anemic
Be sure to discuss this with your doctor.
Receiving Blood From a Donor
Blood from a donor means that the blood you will receive has come from the national blood supply, which has never been safer. However, risks still exist from receiving donated blood, such as the transmission of disease and infection, or an allergic reaction. Be assured, all donated blood is screened, based on the donor’s lifestyle and medical history, as well as for several diseases, including AIDS (HIV) and hepatitis.
Donated blood is also tested for compatibility. Each person has one of the four blood types: A, B, AB, or O. When you receive a transfusion, the donor’s blood you type is “matched” to your blood type. This reduces the possibility of your body rejecting or reacting to the transfusion.
Patients who receive donated blood have a longer hospital stay than patients who do not, independent of other factors.
Building Your Own red Blood Cells
Procrit® (Epoetin alfa)1 is a medication used in anemic patients undergoing elective surgery. It is a natural substance identical to one your body produces and helps stimulate your body’s ability to produce red blood cells. By increasing the red blood cell supply before surgery, the hemoglobin level is increased and remains higher during and after surgery.
When Procrit® is given before surgery, patients produce additional red blood cells and have a significant increase in hemoglobin by day of surgery. Medical studies show that patients who use Procrit® require fewer transfusion than patients who do not. Essentially, they are able to build the red blood cells within their bodies and even after surgery have higher hemoglobin than patients receiving placebo.
Procrit® is used for elective, noncardiac, nonvascular surgery with a likelihood of significant blood loss. Your Hb level must be greater than 10 but less than or equal to 13 g/dL before you start Procrit® therapy. Procrit® is not indicated for anemic patients who are willing to give their own blood.
Are There Any Side Effects to Procrit®?
Most patients taking PROCRIT do not experience any problems. In medical studies, a few patients experienced some type of thrombotic/vascular event (for example, blood clots) after surgery. These are common in major surgery and occurred both in patients on PROCRIT and in those not receiving PROCRIT in the recommended population of patients with Hb 10-13 g/dL. Patients in these studies were given medications to lessen the chance of developing blood clots. Some patients on PROCRIT also had fever, nausea, and/or constipation. These are common side effects in patients who have had major surgery or take iron supplements. For more information, please visit the Procrit® (www.procrit.com) website.
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