The Use of Preoperative Epoetin-α in Revision Hip Arthroplasty

PURPOSE: To evaluate the efficacy of preoperative epoetin-α on the revision hip arthroplasty patient. We hypothesized that epoetin-α will reduce blood transfusion. A pertinent review of the literature is provided. METHODS: Forty-six patients were retrospectively reviewed. Sixteen patients received epoetin-α. Patients were case matched by age, preoperative hemoglobin, surgery, gender, and BMI. The clinical triggers for blood transfusion during or after the procedure were determined based on peri- and postoperative hemoglobin levels, ASA score, and/or clinical symptoms consistent with anemia. Blood salvage was not used. RESULTS: Blood transfusion and length of stay were decreased in the epoetin-α group. Hemoglobin in the intervention group increased from 12.0 to 14.5, preoperatively. Patients who received epoetin-α were 0.78 (RR=0.225) times as likely to receive a transfusion. Number Needed to Treat (NNT) to avoid one allogeneic transfusion was 1.84. Age, Gender, BMI, ASA, total and hidden blood loss, preoperative Iron supplements, preop Hct, preop PLT, PT, PTT, and INR were similar. One (6.0%) patient developed an uncomplicated deep venous thrombosis in the intervention group. CONCLUSIONS: The mildly anemic revision hip arthroplasty patient is at increased risk for transfusion. Epoetin-α increased preoperative hemoglobin counts and reduced transfusions in this study; it also decreased patient length of hospital stay likely allowing for an earlier readiness to resume normal activities and/or meet short-term milestones. A randomized study to evaluate the direct and indirect costs of such a treatment methodology in the mildly anemic revision patient may be warranted

Allogeneic Transfusion after Predonation of Blood for Elective Spine Surgery

The literature suggests preoperative autologous blood donation in total joint arthroplasty is associated with increased overall transfusion rates compared with nondonation and is not cost-effective for all patients. We asked whether the amount of intraoperative blood loss and blood replacement differs between autologous donors and nondonors in elective spine surgery and whether the rates of allogeneic blood transfusions differ between the two groups; we then determined the cost of wasted predonated units. We retrospectively reviewed 676 patients who underwent elective lumbar spine surgery and compared relevant data to that in a matched cohort of 51 patients who predonated blood and 51 patients who received only cell-saver blood and underwent instrumented spinal fusion. Patients who predonated blood had similar blood loss as patients who did not predonate, but they had more blood replacement (1391 cc compared with 410 cc). Patients who predonated blood also had a lower preoperative hemoglobin level and wasted a half unit of blood on average. There was no major difference in allogeneic blood transfusion rates between the two groups. Our data suggest for short, instrumented lumbar fusion surgeries in patients with a normal coagulation profile, preoperative blood donation is not beneficial

Isolation and characterization of microsatellite loci in the stingless bee Melipona interrupta manaosensis (Apidae: Meliponini)

Melipona interrupta manaosensis is an important pollinator in the Neotropics. This stingless bee is reared by locals for honey production and also for conservation purposes. Eleven microsatellite markers were isolated from M. i. manaosensis and characterized in 32 individuals from the Meliponary of the Instituto Nacional de Pesquisas da Amazônia, Manaus, AM, Brazil. The number of alleles observed for each locus ranged from 2 to 5 (average 2.77). The polymorphism information content (PIC) varied between 0.08 to 0.62 (average 0.34) and the discriminating power (D) ranged from 0.61 to 0.99 (average 0.85). The observed heterozygosity (H O) and the expected heterozygosity (H E) ranged from 0.04 to 1.00 and 0.04 to 0.67, respectively. These microsatellites will be useful for future genetic studies of M. i. manaosensis populations and correlated species contributing with Amazon biodiversity preservation. © Springer Science+Business Media B.V. 2009

Microsatellite loci for an endemic stingless bee Melipona seminigra merrillae (Apidae, Meliponini) from Amazon

Melipona seminigra merrillae is one of the main pollinators of Central Amazon native flora. These stingless bees are reared as economic alternative and for forest conservation purposes. Nine polymorphic microsatellite markers were characterized in 44 genotypes of M. seminigra merrillae from the Meliponary of the Instituto Nacional de Pesquisas da Amazonia, INPA (3° 05.838′S 059° 59.103′W), Manaus, Brazil. The number of alleles observed for each locus ranged from 3 to 8, with an average of 3.7 alleles per locus. The polymorphism information content (PIC) varied between 0.21 and 0.81 (average 0.50) and the discriminating power (D) ranged from 0.59 to 0.98 (average 0.77). The observed heterozygosity (H o) and the expected heterozygosity (H e) were 0.04-0.68 and 0.19-0.84, respectively. A cross-amplification test in three Melipona species suggested potential transferability of these microsatellites. These microsatellite markers should be useful for characterizing natural populations and specie conservation. © Springer Science+Business Media B.V. 2009