Blood transfusion following primary hip arthroplasty: immune modulation and infection

Orthopaedic Proceedings. Supplement of the Journal of Bone and Joint Surgery


Blood transfusion is associated with an increased incidence of post-operative nosocomial infections following surgery. In a prospective study we evaluated the association of blood transfusion and the changes in the immune status with the incidence of infection in the post-operative period following primary hip arthroplasty and subsequently for two years following surgery

Method: Prospective analysis of 100 patients undergoing primary total hip replacement. 25 patients received predonated autologus blood transfusions, 26 received SAGM whole blood, 23 received leukocyte depleted blood and 26 did not require a transfusion.

T-helper cell, cytotoxic T cell and NK cell activity was recorded using a Beckton Dickson flow cytometer and assays of Plasma viscosity, CRP, Staph. Epidermis and ASO titres were analysed. All infections were recorded for 2 years following surgery.

Results: he incidence of confirmed or suspected nosocomial infections following hip replacement was the same in non transfused patients as those receiving predonated autologus blood (19%). The incidence of nosocomial infection in patients receiving leukocyte depleted blood was 32% and 42% in those receiving a SAGM blood transfusion. ASO titres were raised in 16.9% of the patients on day 8 following surgery and Staph. Epidermis assays were raised in 20.2% of the patients however the frequency was unrelated to the type of blood transfusion.

The incidence of nosocomial infections was reflected by a greater reduction in NK activity and CD4: CD8 ratio following surgery in patients receiving SAGM blood transfusion.

Conclusion: Homologus blood transfusion may produce an immune compromise in patients, which is still detectable at 6 weeks following surgery. This is clinically reflected by a higher incidence of systemic infections in the postoperative period.

Homologus blood should be used judiciously in joint arthroplasty with a preference to either leukocyte depleted blood or predonated autologus blood.