I have yet another feather to add to the cap of blood-transfusion side-effects. Blood transfusions during or after joint replacement surgeries appear to be an independent risk factor for prosthetic joint infection risk to patients following joint arthroplasties. A large scale retrospective study published in 2019 showed a higher risk of superficial and deep wound infections in hip and knee replacement patients who received blood transfusions. A meta-analysis or mulitple studies published prior in 2017, showed the same link.
The connection seems weird at the outset since bood stored in blood banks is supposed to be sterile – but this link is more indirect in nature. Blood transfusions are known to modify & suppress immunity in patients, also stored blood appears to build up functional and structural changes that increase over time. These changes – called “storage lesions” – is the basis of a 2019 study showing transfusion of blood older than 14 days was a bigger infection risk than fresher blood, the same study also showed more the number of blood transfusions, higher the infection risk.
💡 So what’s our take-home point ? Prosthetic joint infections are nasty – so an ounce of prevention is definitely worth more than a pound of cure. Avoiding the need for blood transfusions in the first place is a good idea to reduce infection risk!
– If a patient has an upcoming elective joint replacement , screen for anemia. Address it prior even if mild.
– Tranexamic acid before surgery to reduce excess bleed risk (oral preferred to IV).
– Stop post-op IV fluids early to prevent hemodilution.
– Address post-op hypotension asscioated with surgical blood loss first with IV fluids and Midodrine (if not contradicated) to avoid transfusions. To reduce post-op hypotension risk, I also like to hold patient’s hypertension meds on the day of surgery, except for beta-blockers.
– Since blood loss is inevitable during such surgeries, perhaps Acute Normovolemic hemodilution should be explored in high-risk patients.
– If a transfusion is unavoidable, be super miserly in the number of units transfused.
– As a side-note, remember post-bleed iron replacement in patients.
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