Karthikeyan E. Ponnusamy,Thomas J. Kim,Harpal S. Khanuja

Blood transfusion after orthopaedic surgery accounts for 10% of all packed red blood-cell transfusions, but use varies substantially across hospitals and surgeons.

Transfusions can cause systemic complications, including allergic reactions, transfusion-related acute lung injury, transfusion-associated circulatory overload, graft-versus-host disease, and infections.

Tranexamic acid is a new cost-effective blood management tool to reduce blood loss and decrease the risk of transfusion after total joint arthroplasty.

Current clinical evidence does not justify transfusions for a hemoglobin level of >8 g/dL in the absence of symptoms.

Studies have also supported the use of this trigger in patients with a history or risk of cardiovascular disease.