Abstract
Background: Whether to cross match or simply group and save for a primary THR is still a matter of debate. The argument in favour of cross match being immediate availability of blood and against it being wastage of resources, underutilization of cross matched samples etc.
Patients & Methods: We retrospectively analyzed the records of 136 patients who underwent primary THR at Manchester Royal Infirmary in 2004.
Result: Of the 136 patients, 104 had 220 units of blood cross matched. The average blood loss was 520 mls. The average pre op. Hb level was 12.8 g/dl while the average post op. Hb levels at 1, 3 & 5 days were 9.4, 9.9 & 10.1 gms/dl resply. Blood loss in patients on pre op. anticoagulant treatment (n = 44) was 596 mls while in the rest, it was 502 mls. The drop in Hb levels between the 2 groups was 3.6 gms/dl and 3.1 gms/dl resply. Patients with drain had an average drop in Hb level of 3.5 gms while it was 3.1 gms in others. The overall transfusion rate was 43.7 %. The most common reason for transfusion was asymptomatic low Hb (< 8 g/dl). Out of the 220 cross matched units, 99 (44.8 %) were transfused. Various probabilities like Cross-match to Transfusion ratio, Transfusion Probability & Transfusion Index were used to find out whether the cross matched units are used effectively.
Discussion: The only factor which influenced the transfusion rate was pre-op. Hb value. 79 %of patients required transfusion when pre op. Hb level was < 12 gm/dl.
Conclusion: 1. Group & Save is a safe policy for primary THR’s 2. Cross match only for patients with Hb of < 12gms/ dl. 3. Consider oral/IV iron therapy, autologous blood transfusion and retransfusion drain 4. Use of Aprotinin and transanamic acid reduces bleeding during surgery.
Correspondence should be addressed to Mr Bimal Singh, BOSA at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE
