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A Novel Way to Manage Blood in Patients Having Both Knee Joints Replaced

Patients with arthritis sometimes have both knees replaced at the same time. This is called a bilateral operation. In general, there are no more major problems than when only one knee is replaced. However, doctors are concerned by how much blood is lost when a patient has both knees replaced in one operation.

New ways to save blood and donate your own blood before surgery are in use. The program is called blood management. The goal is to reduce blood loss and the need for transfusions. Transfusions are generally safe, but using someone else's blood does carry the possibility of transferring diseases such as HIV and hepatitis.

One way that blood loss can be limited is with the cell saver system. It collects the patient's blood and gives it back during the operation. This is called blood recovery. Yet even with this method, patients may have hidden blood loss that can't be measured. When this happens, a blood transfusion may be needed during surgery. To ensure that enough blood is available, the patient can predonate his or her own blood (autogenic blood) or receive a donation from someone else (allogenic blood).

Doctors can't tell how much blood a patient will lose during a bilateral total knee replacement. The authors conclude that blood recovery is a good way to manage blood loss during this operation. The patient can still donate one or two units of blood for personal use. Combining the cell saver system with autogenic blood donation reduces the volume of blood that would otherwise need to be donated by the patient.

References: Friedrich Bottner, MD, et al. Blood Management after Bilateral Total Knee Arthroplasty. In Clinical Orthopaedics and Related Research. May 2003. Vol. 410. Pp. 254-261.

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