I need to quickly find an article that demonstrates that blood avoidance in the Orthopedic population is viable. Our lead Orthopedic surgeons are claiming that “all� the literature points to using an unrestricted amount of blood.

Thanks,
Mike Columbus

http://tinyurl.com/6l3xy
Transfusion avoidance in orthopedic surgery.
J Cardiothorac Vasc Anesth. 2004 Aug;18(4 Suppl):29S-30S. No abstract available.
PMID: 15368203 [PubMed - indexed for MEDLINE]

We don't have a subscription to this particular journal, but the title indicates it may help...
WDB

__________________
Warren

Here is some information. Perhaps it will help build your case.


To view the rest of this article go to: http://tinyurl.com/59l3p :

Arch Orthop Trauma Surg. 2003 Apr;123(2-3):128-31. Epub 2003 Mar 27

Rapid sequence quadruple joint replacement in a rheumatoid Jehovah's Witness.

Panousis K, Rana B, Hunter J, Grigoris P.

University Department of Orthopaedic Surgery, Western Infirmary, Glasgow, UK. panousis@hotmail.com

To view the rest of this article go to: http://tinyurl.com/59l3p :


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You guys are the best! Thanks!

Mike Columbus

Here are three other articles that might be of help:

1. The American Surgeon Vol 61, January 1995 74

Erythropoietin Accelerates Hematocrit Recovery in Post-Surgical Anemia

Umur Atabek, M.D., Richard K. Spence, M.D., et al.


We evaluated the role of recombinant human erythropoietin (RHE) for treatment of severe postsurgical anemia (Hct < 25%) in 40 Jehovah’s Witness (JW) patients refusing transfusion. Twenty patients (group E) received RHE either at a loading dose of 300 U/kg iv 3 times/week for 1 week followed by 150 U/kg 3 times/week in accordance with an IRB approved protocol (N = 13), or at a dose of 100 U/kg 3 times/week for humanitarian reasons (N = 7). This group was compared to 20 similar JW patients who did not receive RHE (group C). All patients received iron restoration and nutritional support. Non-parametric analysis (Mann-Whitney) was used because of sample size.
Entry hematocrit was similar for both groups: HE(0) = 15.8% ± 1.1 SEM (8.5—23.4) vs HC(0) = 12.8% ± 0.9 SEM (7.3—20.6), P = 0.09.
After one week, hematocrit was significantly higher in group E (HE(1) = 19.3% ± 1.1 vs HC(1) = 12.5% ± 0.9, P <0.005) as was the increase in hematocrit (3.6% ± 0.9 for E vs --0.4% ± 0.8 for C, P <0.005). Hematocrit change in Week 2 showed an increase for both groups (2.9% ± 0.6 for E vs 4.9% ± 1.2 for C, P = 0.12). Conclusions: Hct recovery shows a 1-week lag in severely anemic postsurgical patients treated without RHE. Exogenous RHE appears to accelerate hematocrit recovery in the first week. Use of RHE in the immediate postoperative period may help avoid or reduce homologous blood transfusion.


2. Clin Orthop 1999 Dec;(369):251-61

Primary and Revision Total Hip Replacement in Patients Who Are Jehovah’s Witnesses.

Nelson CL, Stewart JG.

The Jehovah’s Witnesses do not accept allogeneic blood transfusion or certain types of autologous blood transfusion and, therefore, present the orthopaedic surgeon with a challenge in the management of perioperative blood loss. Accepting a patient who is a Jehovah’s Witness as a surgical candidate requires the surgeon to be prepared medically to use known techniques to limit red blood cell loss or increase red blood cell mass, to resort to extraordinary means when necessary, and to be prepared philosophically to deal with catastrophic blood loss in a patient who may refuse even potentially life-saving transfusion. Issues pertinent to the management of intraoperative blood loss in the patient who is a Jehovah’s Witness require careful delineation and specific treatment guidelines. The authors herein review their past and current experiences in the perioperative blood management of this patient population in an attempt to address this need.


3. Am Surg 1998;64(11): 1074-6

Extended hemipelvectomy in a Jehovah’s Witness with erythropoietin support.

Meyers MO, Heinrich S, Kline R, Levine EA.

The care of patients refusing blood transfusion who require major ablative surgery for malignancy is a continuing challenge. The use of recombinant human erythropoietin is clearly efficacious in patients with renal disease and may be useful in anemic patients who refuse transfusion. Herein, we report a successful extended hemipelvectomy in a Jehovah’s Witness using recombinant human erythropoietin support.