Hemoglobin Drop and the Need for Transfusion in Primary Knee Arthroplasty

Hemoglobin Drop and the Need for Transfusion in Primary Knee Arthroplasty

BackgroundBlood loss is still a serious adverse effect of total knee replacement (TKR), resulting in Hemoglobin drop and a higher need for blood transfusions. Multiple modalities are used to reduce intra-operative blood loss and hemoglobin drop for this procedure, such as placing a drain intraoperat...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) Vol. 14; no. 8; p. e27659
Main Authors: Madan, Fatema H, Khamis, Ebrahim, Alhassan, Mohamed Aqeel, Alrashid, Maryam, Saleh, Ahmed, Rahma, Mohamed
Format: Journal Article
Language:English
Published: Palo Alto Cureus Inc 03-08-2022
Cureus
Subjects:
Acids
Age
Antifibrinolytic agents
Blood
Blood transfusions
Bone surgery
Gender
Hematoma
Hemoglobin
Hospitals
Infections
Joint replacement surgery
Knee
Orthopedics
Osteoarthritis
Osteopathic Medicine
Other
Patients
Regression analysis
Rheumatoid arthritis
Surgeons
Thrombosis
Wound dehiscence
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Summary:BackgroundBlood loss is still a serious adverse effect of total knee replacement (TKR), resulting in Hemoglobin drop and a higher need for blood transfusions. Multiple modalities are used to reduce intra-operative blood loss and hemoglobin drop for this procedure, such as placing a drain intraoperatively and Tranexamic acid (TXA) administration. This study aimed to investigate factors associated with hemoglobin loss and blood transfusion increased demand.Patients and methodsWe retrospectively looked at 223 patients who underwent primary unilateral or staged bilateral knee arthroplasty by a single surgeon from January 2013 until April 2018 in Salmaniya Medical Complex (SMC), Bahrain. We looked into patients' demographics such as age, gender, preoperative hemoglobin and hematocrit, postoperative hemoglobin and hematocrit, drain insertion intra-operatively, and the administration of Intravenous tranexamic acid intra-operatively. Eighty-three patients had a drain inserted intra-operatively, and sixty-nine patients received intra-venous Tranexamic acid during the procedure.ResultsOut of 223 patients, 152 patients were included after applying exclusion criteria. The mean hemoglobin (Hb) loss in patients who had a drain inserted was 2.186 g/dL, while patients who received tranexamic acid had a mean of 1.609 g/dL. Multivariable regression analysis revealed that increased blood transfusion requirements postoperatively were significantly associated with reduced pre-operative Hemoglobin levels (p-value .004). Univariable analysis of the hemoglobin drop showed that the use of TXA would reduce Hb loss while a drain would increase Hb drop (p-value .003 and .002, respectively). Moreover, univariable analysis of blood transfusion requirements showed reduced pre-operative Hb, and placing a drain would increase blood transfusion demand (p-value <.001, .044 respectively), while administration of tranexamic acid would reduce blood transfusion demand (p-value 0.05).ConclusionReducing the need for blood transfusion following primary total knee arthroplasty can be achieved by maintaining preoperative hemoglobin levels, administering tranexamic acid intra-operatively, and avoiding placing an intra-articular drain.
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ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.27659