Korean J Blood Transfus.  2019 Apr;30(1):15-22. 10.17945/kjbt.2019.30.1.15.

Blood Management Protocol without Transfusion in Orthopedic Surgery

  • 1Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea. huuy@schmc.ac.kr
  • 2The Center for Bloodless Medicine and Surgery and Patient Blood Management, Soonchunhyang University Hospital Seoul, Seoul, Korea.


We developed a new blood management protocol that allows patients to not undergo transfusion during major orthopaedic surgery. Here, we report the safety of or our protocol. The preoperative pharmacological protocol consisted of the administration of 40 µg of recombinant erythropoietin subcutaneously and 100 mg of iron supplements intravenously. During the operation, reinfusion of drainage blood using a cell saver and plasma expander was used. The cell saver device passed the collected blood through a filter, which washed the blood, removing the hemolyzed cells and other impurities. Intravenous tranexamic acid 1 g is given just before the operation, except high-risk patients for venous thromboembolism. Postoperatively, recombinant erythropoietin and iron supplements were administered in the same manner with the preoperative protocol and continued until a hemoglobin level reached 10 g/dL.


Orthopaedic surgery; Patient blood management; Transfusion; Erythropoietin; Tranexamic acid
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