Autologous blood transfusion in revision hip arthroplasty. A prospective, controlled study of 30 patients.

In a prospective, randomized study of the efficacy and effects of autologous blood transfusion in revision hip arthroplasty, 30 patients were randomly allocated into two groups. The Control Group received homologous blood transfusion. The Study Group deposited 2-3 units of blood preoperatively, intraoperative blood salvage was used, and no homologous blood was transfused intraoperatively. There was a smaller postoperative blood loss in the Study Group. The preoperative hemoglobin values were lower in the Study Group, but one week postoperatively they were higher than in the Control Group. The decrease in the values of AT III and protein C was lower in the Study Group. The combination of preoperative blood donation and intraoperative blood salvage reduced blood loss and homologous blood transfusion in revision hip arthroplasty.

Intraoperative autotransfusion in hip arthroplasty. A retrospective study of 214 cases with matched controls.

The transfusion requirements in 214 patients who received intraoperatively collected autologous blood during total hip arthroplasty (Study Group) were compared with 214 age- and sex-matched controls who received homologous bank blood (Control Group). There were 132 patients with primary operations, 27 bilateral, and 55 revisions in each group. In the Study Group, there was a reduction in the amount of homologous blood transfusion, intraoperatively as well as totally, and also in postoperative blood loss in all three operation subsets. The Study and Control Groups were equal in pre- and postoperative hemoglobin and hematocrit values.

Intraoperative autotransfusion in primary hip arthroplasty. A randomized comparison with homologous blood.

To study the quality and effect of blood produced by the cell saver compared with homologous blood in total hip arthroplasty, 40 patients were randomly divided into two groups. One group received autologous blood using the cell saver, whereas the second group served as a control, and received homologous bank blood. Hematologic and coagulation parameters of the patients were assessed both preoperatively and postoperatively. Samples from the autologous and the homologous blood were obtained before reinfusion, and were assessed as regards hematologic and biochemical parameters. The autologous blood satisfied all the intraoperative transfusion requirements of the autologous group and 75 percent of the total transfusion requirements. The operative and postoperative blood losses--hence, the total blood loss--were less in the autologous than in the control group. The autologous blood had a high hemoglobin, white blood cell, and plasma hemoglobin content and MCV compared with the homologous blood. Postoperatively, there were no differences as regards the hematologic parameters studied. There was no evidence of intravascular hemolysis in the autologous group. Postoperatively, in both groups, AT III, plasminogen, and protein C decreased. Other coagulation parameters were within normal limits in both groups. Intraoperative autotransfusion is safe and effective, and should be considered in hip arthroplasty to reduce the risks associated with homologous blood transfusion.

Elderly patients' responses to preoperative autologous blood collection.

OBJECTIVE: To follow the haematological response in elderly patients to preoperative autologous blood collection. DESIGN: A prospective, randomised study. SETTING: Malmö General Hospital, Sweden. PATIENTS: Sixty patients with a mean age of 71 years (range, 60-82 years) who were to undergo total hip replacement were randomly divided into four groups of 15. One group served as control. Three units of blood were collected from patients in the other three groups, the first unit at least 30 days before the planned operation, with an average interval of 10 days between collections. Iron supplementation was given to one group as a substitution remedy, another group was given iron and folic acid and the third group was without supplementation during the collection period. MAIN OUTCOME MEASURES: Haematological and biochemical tests were performed on blood samples taken at the time of each collection, on the morning of the hip replacement operation, and ten days after and six weeks after the operation. RESULTS: No major complication was encountered with blood collection. The patients tolerated the procedure very well including the substitution remedies. Haematological and biochemical parameters remained within the normal range during the collection period and after the operation. No patient in the autologous groups needed homologous blood during the operation; three units of homologous blood were used after the operation in these patients. CONCLUSION: Preoperative blood collection from the elderly is safe and well tolerated. The procedure should be encouraged in elective orthopaedic operations regardless of age.

Predonation autologous blood in hip arthroplasty.

In a prospective randomized study of elderly patients, a total of 130 units of blood were donated by 45 patients prior to a total hip arthroplasty. Fifteen patients served as controls (no phlebotomy). The average age was 71 (60-82) years. No major complication occurred with phlebotomy. All the patients were able to maintain their hematologic and chemical parameters within the normal range throughout the donation period. The autologous blood covered all the peroperative transfusion needs and 97 percent of the total transfusion requirements. There was less postoperative blood loss, as well as total blood loss, in the autologous groups compared with the control group. There was no difference in the rate of postoperative complications between the groups. The use of predeposited autologous blood in elective orthopedics, regardless of patient age, is feasible, cost effective, and avoids the risks associated with homologous blood transfusion.

The effect of Citrullus colocynthis on sheep.

Fresh Citrullus colocynthis fruits and leaves were fed to ten sheep at daily doses ranging from 0.25 to 10 g/kg. The sheep showed signs of poisoning and died from 4 hours to 25 days after dosing. The clinical signs of diarrhea, anorexia, dyspnea and loss of condition were well correlated with the pathological findings. There was an increase in the concentrations of creatinine, urea and potassium and a decrease in total protein and calcium in the serum and in the blood sugar level of Colocynthis-poisoned sheep. Changes in the concentrations of serum phosphorus and magnesium were inconsistent. Hematological changes indicated the development of hemoconcentration. Leucocytosis resulted from an increased number of neutrophils.

Toxicity of five Sudanese plants to young ruminants.

The toxicity of 5 Sudanese plants credited with medicinal value for man, i.e. Citrullus colocynthis, Jatropha aceroides, J. glauca, Solanum dubium and Lagenaria siceraria, was studied by giving the dried or minced plants to Nubian goats, Desert sheep or Zebu calves by mouth or stomach tube. The clinical, haematological and pathological changes indicated that all five plants reduced the ability of the liver to synthesize protein, although there was no evidence of interference with the excretion of bilirubin. Kidney dysfunction and haemoconcentration also occurred. Citrullus colocynthis and Jatropha species in doses of 0.5 to 10 g per kg per day killed goats after dosing for periods ranging from 1 day to 2 weeks. Calves were less susceptible. The fruits and leaves of L. siceraria, in doses of 1 to 5 g per kg per day, caused death after a similar period but with less regularity. The seeds were less toxic. The fruits of S. dubium in doses of 2.5 to 10 g per kg per day killed goats in 2 to 5 days. Similar doses of the leaves caused deaths in 8 to 36 days. In sheep, both fruits and leaves required a longer period of dosing to cause death.