Should We Use Preoperative Epoetin-α in the Mildly Anemic Patient Undergoing Simultaneous Total Knee Arthroplasty?
Lawrence A Delasotta*, 1, Fabio Orozco 2, 3, 4, S. Mehdi Jafari 5, Jamie L Blair 2, Alvin Ong 2, 3, 4
1 Department of Orthopedics, Kingsbrook Jewish Medical Center, Brooklyn, NY 11203, USA
2 Rothman Institute, Egg Harbor Township, NJ 08234, USA
3 Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
4 Orthopaedics Division at AtlantiCare Regional Medical Center, USA
5 Nirschl Orthopaedics at Virginia Hospital Center, Arlington, VA 22205, USA
Simultaneous knee arthroplasty is associated with significant blood loss. To prevent transfusion, three preoperative doses of epoetin-α were offered to mildly anemic simultaneous knee arthroplasty patients. A retrospective review, using ICD-9 codes, identified twenty patients from 2007-2009. Epoetin-α increased hemoglobin levels preoperatively (12.6 to 13.9, p<0.01). Twenty patients who did not receive epoetin-α were matched to study patients. Study patients were transfused less (55% vs 95%, p=0.012) and had similar inpatient length of stay. The average blood loss without transfusion was 4.6g/dL. The mildly anemic patient is at high-risk for packed red cell transfusion during simultaneous knee arthroplasty. Three preoperative doses of epoetin-α in the mildly anemic patient decreased total transfusions; however, it did not affect inpatient length of stay.
Keywords: Single stage bilateral total knee arthroplasty, simultaneous total knee arthroplasty, epoetin-α, tranexamic acid, degenerative joint disease, pain, anemia.
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* Address correspondence to this author at the Department of Orthopedics, Kingsbrook Jewish Medical Center, 585 Schenectady Avenue, Brooklyn, NY 11203, USA; Tel: 718-604-5483; Fax: 215-707-1915; E-mail: LawrenceDelasotta@Gmail.com