Effect of Tranexamic Acid on Hematologic Values and Blood Loss in Reverse Total Shoulder Arthroplasty

Purpose. Use of tranexamic acid (TXA) in the setting of arthroplasty of the lower extremity has been previously described. The aim of this study was to evaluate the benefit of a single dose of TXA (500 mg vial) administered intravenously just prior to RTSA in an Asian population. Methods. The records of 48 patients (no TXA, n=24, versus TXA, n=24) that underwent RTSA for cuff tear arthropathy were retrospectively reviewed. All patients had a Hemovac drain positioned for 2 days after surgery. Hemoglobin (Hb) and hematocrit (Hct) were checked on postoperative day 2 and compared with preoperative levels. Results. Hematologic change on postoperative day 2 as determined by Hb level after surgery was statistically lower in the TXA group (2.8±0.8 versus 2.1±0.8 (mg/dL), P=0.006). Mean fall in Hct level was also significantly less in the TXA group (8.0±2.5 versus 6.1±2.6 (L/L), P=0.012). Total Hemovac drainage tended to be lower in the TXA group (263.4±129.3 versus 203.5±84.2 (ml), P=0.064). TXA was found to have no noticeable side effects. Conclusion. The use of a single intravenous dose of TXA immediately prior to RTSA reduces hematologic deterioration postoperatively and the amount of Hemovac drainage. TXA could avoid unnecessary transfusion and its associated medical side effects and cost.

Effect of methylcellulose injection on murine hematopoiesis

This study was designed to determine the effect of methylcellulose (MC)-induced reticuloendothelial (RE) hypertrophy on neutrophils and hematopoietic stem cells and to contrast its overall hematologic effect in the mouse to the more frequently studied rat model. Mice were given MC 3 times/wk and studies were done at 2, 3, and 4 wk, with maximal hematologic change by 2 wk. A stable, but incompletely compensated hemolytic anemia developed which was accompanied by a significant shift of erythropoiesis from marrow to spleen. Thrombocytopenia developed as did neutrophilia, accompanied by an increased number of marrow neutrophil precursors. Extramedullary hematopoiesis was observed in the liver. The number of cells forming spleen colonies in irradiated recipients increased in the spleen but not in marrow. The number of cells producing granulocyte and macrophage colonies in semisolid media increased in spleen and marrow. Splenectomized mice, treated with MC, developed changes very similar to intact mice. Thus, it appears that all three major hematopoietic lines may be destroyed by the MC-hypertrophied RE system. The mouse differs from the rat in its hematologic response to MC by destroying cells in organs other than the spleen, by increasing neutrophil production, by developing hepatic hematopoiesis, and by developing all changes more rapidly.

Attempted Passive Transfer of Thrombotic Thrombocytopenic Purpura

Transfusion of 300 ml. of plasma from a patient with thrombotic thrombocytopenic purpura produced no hematologic change in a healthy recipient; 10 months after the infusion there has been no evidence of transmission of any disease.