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Perioperative Blood Transfusions in Orthopaedic Surgery

Ponnusamy, Karthikeyan E. MD; Kim, Thomas J. MD; Khanuja, Harpal S. MD

Journal of Bone & Joint Surgery - American Volume: 5 November 2014 - Volume 96 - Issue 21 - p 1836–1844
doi: 10.2106/JBJS.N.00128
Current Concepts Review
Supplementary Content

➤ Blood transfusion after orthopaedic surgery accounts for 10% of all packed red blood-cell transfusions, but use varies substantially across hospitals and surgeons.

➤ Transfusions can cause systemic complications, including allergic reactions, transfusion-related acute lung injury, transfusion-associated circulatory overload, graft-versus-host disease, and infections.

➤ Tranexamic acid is a new cost-effective blood management tool to reduce blood loss and decrease the risk of transfusion after total joint arthroplasty.

➤ Current clinical evidence does not justify transfusions for a hemoglobin level of >8 g/dL in the absence of symptoms.

➤ Studies have also supported the use of this trigger in patients with a history or risk of cardiovascular disease.

1c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A665, Baltimore, MD 21224-2780. E-mail address:

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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