Preoperative Autologous Donation for Hip Replacement

To The Editor: In “A Prospective, Randomized Study of Preoperative Autologous Donation for Hip Replacement Surgery” (2002;84:1299-304), Billote et al. concluded that “preoperative autologous donation provided no benefit for nonanemic patients”; however, I fear that many readers may be misled into believing that this statement is true for all patients undergoing hip arthroplasty. Because this study was not similar to any prior studies of autologous transfusion, the differences should be emphasized. First, it was a selected series of patients undergoing hip arthroplasty, as evidenced by the fact that all patients had a normal hemoglobin level, none had major medical comorbidities, a majority of the patients were male, and the average age of the patients was four or five years younger than that of most hip study populations. It would be unfair to compare this series of selected patients with studies of series of unselected hip arthroplasty patients. It would be interesting to know how many other hip arthroplasty patients were treated during the study period but were not included in this study group because of a lack of consent or because of exclusion criteria. I would also be interested to know why a hemoglobin level of 120 g/L was used as the admission criterion when it is universally accepted that patients may donate autologous blood if their hemoglobin level is >110 g/L. It appears that this exclusion criterion further limited the patient population to patients with a high hematocrit only, and not to all patients who would be eligible to donate autologous blood. Second, the authors used a very stringent hemoglobin threshold as a criterion for allogeneic transfusion by requiring that the hemoglobin level be <70 or 80 g/L (or a hematocrit of <0.21 or 0.24) prior to ordering an allogeneic transfusion. Most blood bank committees use a hemoglobin level …