The journal of knee surgery
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Primary or revision total knee arthroplasties (TKAs) may be associated with a marked amount of intraoperative or postoperative blood loss that potentially may lead to the need for blood transfusions. However, Jehovah's Witnesses usually refuse blood transfusions because of their religious beliefs. ⋯ In this report, we provide an overview of various potential preoperative, intraoperative, and postoperative blood management measures that may be used for the care of Jehovah's Witnesses who undergo knee arthroplasty procedures. In addition, we review reported outcomes of primary and revision TKAs in these patients.
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Elective total knee arthroplasty is frequently associated with considerable blood loss and a concomitant decline in hemoglobin postoperatively. This often leads to high rates of allogeneic transfusions, with reports of up to 69%, to treat postoperative anemia. Allogeneic blood transfusions have been shown to be an independent risk factor for increased adverse outcomes, such as prolonged length of hospital stay and postoperative infections. ⋯ Specifically, we evaluated preoperative autologous blood donation, iron therapy, and intravenous erythropoietin. Current evidence suggests that these techniques independently may be effective at reducing the incidence of allogeneic blood transfusions, correcting preoperative, and preventing postoperative anemia. However, more studies are necessary to evaluate combination protocols, as well as the cost-effectiveness and safety of these practices as part of routine preoperative blood management for total knee arthroplasty.