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Major elective orthopaedic surgery is often associated with the necessity for allogeneic blood transfusion. Bierbaum et al. [2] collected data on blood management from a total of 9482 patients who underwent a total hip replacement or total knee replacement. Of the total patient population, almost half (46%) received a blood transfusion. Of the patients requiring transfusion, 34% received allogeneic blood. Compared with patients who did not receive a transfusion, patients who were transfused with allogeneic blood were more likely to develop infection (P≤0.001), fluid overload (P≤0.001), and increased duration of hospital stay ( P≤0.01). Because allogeneic transfusions carry risks of viral disease transmission, allergic reactions, and posttransfusion immunosuppression (Table 1), [12, 19, 29, 30, 37] orthopaedic surgeons have investigated various blood management strategies in orthopaedic surgery to reduce patient exposure to allogeneic blood [26]. Although innovations in surgical technique and autologous blood options reduce the risk from allogeneic blood transfusions, these techniques alone are unlikely to completely protect patients who are anaemic at the time of surgery. The stimulation of red blood cell (RBC) production by erythropoietin therapy is one means of treating this anemia preoperatively [20].

Blood conservation in orthopaedic surgery: the role of epoetin alfa