Preoperative autologous blood donation by arthritis patients is associated with preoperative anemia and perioperative transfusion

Background: Preoperative autologous blood donation (PAD) became a common practice in the 1990s in an attempt to reduce the risk of transmission of infectious agents from allogeneic blood. However, a potential risk of PAD is the development of preoperative anemia that may lead, in turn, to an enhanced need for transfusion. Furthermore, the ready availability of autologous blood may predispose to more liberal transfusion peri-/postoperatively. Objectives: To examine these hypotheses, we retrospectively examined a cohort of knee and hip arthroplasty patients. Methods: Charts of patients of 2 orthopedic surgeons from the mid 1980s and 1990s were reviewed for transfusions needed and hematocrits before and after arthroplasties. Results: PAD proved to be a significant risk factor for the development of preoperative anemia and for peri-/postoperative blood transfusion even after adjusting for confounders. Conclusions: These results suggest that PAD may lead to a self-defeating cycle of blood donation followed by blood transfusion. With the improved safety of the allogeneic blood supply, rheumatologists may want to play a more active role in considering PAD in patients in whom elective arthroplasty is planned.