Preoperative predictors for allogenic blood transfusion in hip and knee arthroplasty for rheumatoid arthritis

2013 ◽  
Vol 133 (9) ◽  
pp. 1315-1320 ◽  
Author(s):  
Ann E. Ogbemudia ◽  
Sze Y. Yee ◽  
Gavin J. MacPherson ◽  
Lynn M. Manson ◽  
Steffen J. Breusch
Keyword(s):  
Rheumatoid Arthritis ◽  
Blood Transfusion ◽  
Knee Arthroplasty ◽  
Allogenic Blood Transfusion ◽  
Allogenic Blood ◽  
Hip And Knee Arthroplasty ◽  
Preoperative Predictors

scholarly journals Low blood transfusion rate after implementation of tranexamic acid for fast- track hip- and knee arthroplasty. An observational study of 5205 patients

2021 ◽  
Vol 87 (1) ◽  
pp. 9-16
Author(s):  
Yoeri Bemelmans ◽  
Emil Van Haaren ◽  
Bert Boonen ◽  
Roel Hendrickx ◽  
Martijn Schotanus
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Allogenic Blood Transfusion ◽  
Transfusion Rate ◽  
Allogenic Blood ◽  
Estimated Blood Loss ◽  
Duration Of Surgery ◽  
Hip And Knee Arthroplasty

The purpose of this study was to retrospectively evaluate the efficacy of a tranexamic acid (TXA) perioperative protocol for primary hip- and knee arthroplasty, in terms of allogenic blood transfusion rates. A retrospective cohort study was conducted and included all primary hip and knee arthroplasty procedures in the period of 2014-2019. Patients who underwent surgery due to trauma or revision were excluded. A total amount of 5205 patients were eligible for inclusion. Two equal and weight depending doses of TXA were given, preoperative as an oral dose and intravenously at wound closure. The primary outcome was blood transfusion rate. Further analysis on patient characteristics (e.g. age, gender), blood loss, perioperative haemoglobin (Hb) levels and complication/readmission rate was performed. A total of 49 (0.9%) patients received perioperative allogenic blood transfusions. Mean age, distribution of gender, body-mass index, American Society of Anaesthesiologists score, duration of surgery, type of arthroplasty, estimated blood loss, perioperative Hb levels and length of stay were statistically significant different between transfused and not-transfused patients. The incidence of thromboembolic adverse events (e.g. deep vein thrombosis/lung embolism) was 0.5%. Low blood transfusion rate was found after implementation of a standardized perioperative TXA protocol for primary hip and knee arthroplasty.

scholarly journals Efficacy and Cost Effectiveness of Universal Preoperative Iron Studies in Total Hip and Knee Arthroplasty

2021 ◽  
Author(s):  
Viju Daniel Varghese ◽  
David Liu ◽  
Donald Ngo ◽  
Suzanne Edwards
Keyword(s):  
Blood Transfusion ◽  
Knee Arthroplasty ◽  
Universal Screening ◽  
Intravenous Iron ◽  
Allogenic Blood Transfusion ◽  
Transfusion Rate ◽  
Allogenic Blood ◽  
Total Hip ◽  
Hip And Knee Arthroplasty ◽  
The Difference

Abstract Background Prevalence of anaemia in patients planned for total hip and knee arthroplasty is about 20%. Optimising preoperative haemoglobin levels by iron supplementation has been shown to decrease transfusion rates, complications and associated morbidity. The need for universal screening with iron studies of all elective arthroplasty patients is not clearly defined at present. Methods Retrospective review of 2 sequential cohorts of patients undergoing primary hip or knee arthroplasty by a single surgeon at a single centre between January 2013 and December 2017. The first group of patients underwent pre-operative iron studies only if found to be anaemic, with a haemoglobin below 12g/dL. From January 2015 all patients irrespective of the presence of anaemia were screened with a complete iron profile before surgery. Patients with a confirmed iron deficiency were administered with intravenous iron prior to surgery. The 2 cohorts were compared with regards to blood transfusion rate post-operatively and cost efficiency for universal screening with iron studies. Results There was a net decrease in allogenic blood transfusion rate from 4.76–2.92% when universal iron studies were introduced but the difference was not statistically significant. Obtaining universal pre-operative iron studies is cost neutral with the price of allogenic blood transfusion in a similar cohort. We also diagnosed 5 patients with occult malignancies. Conclusions Universal screening with pre-operative iron studies and iron infusion in elective arthroplasty patients may reduce allogenic blood requirements and is cost neutral. An additional benefit is the potential to diagnose asymptomatic malignancies. Further studies are required to show the true benefit of universal pre-operative iron screening.

scholarly journals Efficacy and cost-effectiveness of universal pre-operative iron studies in total hip and knee arthroplasty

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Viju Daniel Varghese ◽  
David Liu ◽  
Donald Ngo ◽  
Suzanne Edwards
Keyword(s):  
Blood Transfusion ◽  
Knee Arthroplasty ◽  
Universal Screening ◽  
Intravenous Iron ◽  
Allogenic Blood Transfusion ◽  
Transfusion Rate ◽  
Allogenic Blood ◽  
Total Hip ◽  
Hip And Knee Arthroplasty ◽  
The Difference

Abstract Background The prevalence of anaemia in patients planned for total hip and knee arthroplasty is about 20%. Optimising pre-operative haemoglobin levels by iron supplementation has been shown to decrease transfusion rates, complications and associated morbidity. The need for universal screening with iron studies of all elective arthroplasty patients is not clearly defined at present. Methods Retrospective review of 2 sequential cohorts of patients undergoing primary hip or knee arthroplasty by a single surgeon at a single centre between January 2013 and December 2017. The first group of patients underwent pre-operative iron studies only if found to be anaemic, with a haemoglobin below 12g/dl. From January 2015, all patients irrespective of the presence of anaemia were screened with a complete iron profile before surgery. Patients with a confirmed iron deficiency were administered with intravenous iron prior to surgery. The 2 cohorts were compared with regard to blood transfusion rate post-operatively and cost efficiency for universal screening with iron studies. Results There was a net decrease in the allogenic blood transfusion rate from 4.76 to 2.92% when universal iron studies were introduced but the difference was not statistically significant. Obtaining universal pre-operative iron studies is cost neutral with the price of allogenic blood transfusion in a similar cohort. We also diagnosed 5 patients with occult malignancies. Conclusions Universal screening with pre-operative iron studies and iron infusion in elective arthroplasty patients may reduce allogenic blood requirements and is cost neutral. An additional benefit is the potential to diagnose asymptomatic malignancies. Further studies are required to show the true benefit of universal pre-operative iron screening.

scholarly journals Blood Conservation Strategies in Total Hip and Knee Arthroplasty

2015 ◽  
Vol 4 (4) ◽  
pp. 39-45 ◽  
Author(s):  
David Liu ◽  
Michael Dan ◽  
Natalie Adivi
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Conservation Strategies ◽  
Patient Specific ◽  
Allogenic Blood Transfusion ◽  
Transfusion Rate ◽  
Blood Conservation ◽  
Total Hip ◽  
Hip And Knee Arthroplasty

Peri-operative blood management is one of a number of components important for successful patient care in total joint arthroplasty and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risks of blood transfusion whilst at the same time maximizing haemaglobin in the post-operative period, thereby leading to a positive effect on early and long term outcomes and costs. An individualized strategy based on patient specific risk factors, anticipated blood loss and co-morbidities is useful in achieving this aim. Multiple blood conservation strategies are available in the pre-operative, intra-operative and post-operative periods and can be utilised either individually or in combination. Recent literature has highlighted the importance of identifying and correcting pre-operative anaemia, salvaging peri-operative red cells and the use of tranexamic acid in reducing blood loss. Given total hip and knee arthroplasty is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal. 

scholarly journals Tranexamic acid use in simultaneous bilateral total knee arthroplasty : a comparison of intravenous and intra-articular applications, which is more effective?

2021 ◽  
Vol 87 (3) ◽  
pp. 479-486
Author(s):  
Alpaslan Öztürk ◽  
Yavuz Akalin ◽  
Nazan Çevik ◽  
Özgür Avcı ◽  
Oğuz Çetin ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Allogenic Blood Transfusion ◽  
Bilateral Total Knee Arthroplasty ◽  
Allogenic Blood ◽  
Estimated Blood Loss ◽  
Total Knee

Patients applied with simultaneous bilateral total knee arthroplasty (SBTKA) with the administration of intravenous or intra-articular tranexamic acid (TXA) were compared in respect of blood loss and the need for allogenic blood transfusion. Of a total 53 patients applied with SBTKA, 32(60%) were administered intravenous TXA and 21(40%) intra-articular TXA. The patients were evaluated in respect of age, gender, height, weight, body mass index (BMI), body blood volume, preoperative and 1,2,3 and 4 days postoperative levels of hemoglobin (Hb) and hematocrit (Htc) and the change in Hb levels, estimated blood loss, mean actual blood loss, the need for allogenic blood transfusion (ABT) and the use or not of a drain. No difference was determined between the intravenous and intra-articular groups in respect of mean age, gender, height, weight, and body blood volume. No difference was determined between the groups in preoperative and postoperative mean Hb and Hct values, the reduction in mean Hb postoperatively, estimated blood loss, or the need for ABT. No deep vein thrombosis or pulmonary embolism was determined in any patient. In the application of SBTKA, TXA can be safely administered by the intravenous or intra-articular route to reduce the need for ABT. The results of this study determined no difference in efficacy between the routes of application. For patients with a risk of intravenous use, intra-articular application can be preferred.

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