Hemodynamic Analysis of Patients Who Underwent Arthroplasty without Blood Transfusion.
10.4055/jkoa.2010.45.6.456
- Author:
You Sung SUH
1
;
Hyung Suk CHOI
;
Sung Hun WON
;
Myoung Hoe KIM
;
Dong Il CHUN
;
Jae Hwi NHO
Author Information
1. Department of Orthopedic Surgery, Soonchunhyang University College of Medicine, Seoul, Korea. knee@schmc.ac.kr
- Publication Type:Original Article
- Keywords:
arthroplasty;
transfusion;
alternative blood management
- MeSH:
Arthroplasty;
Blood Transfusion;
Blood Transfusion, Autologous;
Hemodynamics;
Hemoglobins;
Hip;
Humans;
Iron;
Joints;
Knee;
Perioperative Period;
Plasma
- From:The Journal of the Korean Orthopaedic Association
2010;45(6):456-463
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To analyze the hemodynamic changes in patients who underwent total joint arthroplasty and received alternative treatment to blood transfusion. MATERIALS AND METHODS: Fifty-seven cases in 48 patients who received total knee and hip arthroplasty between 1998 September and 2008 February were enrolled. The mean age at the point of surgery was 70.9 years. The types of joint arthroplasty included 15 cases of total knee arthroplsty and 42 cases of total hip arthroplasy. Alternatives to blood transfusion entailed administration of 2,000 units of recombinant EPO and oral iron supplement for 1 week in patients with preoperative hemoglobin level higher than 10 g/dl, and 4,000 units of recombinant EPO with oral iron supplement or venoferrum for 1 week in patients with preoperative hemoglobin level lower than 10 g/dl. Intra-operatively, autotransfusion, plasma expander, topical hemostatic agents were used irrespective of the preoperative hemoglobin level. Postoperatively, 4,000 unit of recombinant EPO and venoferrum were administered for one week. RESULTS: Patients with mean hemoglobin level higher than 10 g/dl exhibited mean hemoglobin level of 10.7 g/dl (a mean 1.85 g/dl decrease) 7 days after the operation. Patients with mean hemoglobin level lower than 10 g/dl exhibited increased mean hemoglobin level of 9.18 g/dl (a mean 0.38 g/dl decrease) 7 days after the operation. Patients who underwent total knee arthroplasty exhibited reduction of hemoglobin from 12.8 g/dl to 10.96 g/dl (a mean decrease of 1.4 g/dl) 7 days after the operation. Patients who underwent total hip arthroplasty exhibited a change of hemoglobin from 13.4 g/dl to 11.8 g/dl (a mean decrease of 1.84 g/dl) 7 days after the operation. Patients who underwent revision arhtroplasty exhibited a change of hemoglobin from 13.8 g/dl to 12.75 g/dl (a mean decrease of 1.05 g/dl) 7days after the operation. CONCLUSION: In patients who refuse blood transfusion, there is a need to establish an adequate alternative blood management plan for surgery, such as total joint arthroplasty. We obtained good results with the hemodynamic protocol adapted for the perioperative period.
