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Instructional Course Lecture   |    
Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Current Options and Approaches for Blood Management in Orthopaedic Surgery*†
E. MICHAEL KEATING, M.D.‡, MOORESVILLE, INDIANA
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*Printed with permission of the American Academy of Orthopaedic Surgeons. This article will appear in Instructional Course Lectures, Volume 48, American Academy of Orthopaedic Surgeons, Rosemont, Illinois, March 1999.
J Bone Joint Surg Am, 1998 May 01;80(5):750-62
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Although the implementation of blood-screening measures has vastly reduced the risk of transmission of the human immunodeficiency virus through transfusion of donated blood products, several factors preclude the blood supply from achieving a zero-risk status. Patients who receive perioperative allogenic blood transfusions, for instance, have been reported to have higher rates of infection80,85,116 (although this finding remains controversial37,120) and perioperative blood loss, longer hospital stays26,40, more consecutive days of fever and administration of antibiotics, and a postoperative decrease in natural killer cells116. Furthermore, in a retrospective quantitative analysis of transfusion-associated immunomodulation, transfusion was the most important prognostic factor for postoperative infection13. Finally, the risk of transmission of infectious diseases, such as those caused by hepatitis-B and C viruses99 and to a lesser extent cytomegalovirus29 and Epstein-Barr virus129, as well as the risk of transfusion reactions, alloimmunization, and immunomodulation, remains substantive. Optimization of blood management is thus as important today as it was a decade ago, despite the markedly improved safety of allogenic blood.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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