Kako poboljšati transfuzijsko liječenje bolesnika podvrgnutih ugradnji totalnih endoproteza kuka i koljena? [How to improve perioperative blood management in patients undergoing total hip or knee replacement surgery?]

Oberhofer, Dagmar and Šakić, Kata and Janković, Saša and Tonković, Dinko and Vrgoč, Goran (2012) Kako poboljšati transfuzijsko liječenje bolesnika podvrgnutih ugradnji totalnih endoproteza kuka i koljena? [How to improve perioperative blood management in patients undergoing total hip or knee replacement surgery?]. Lijec̆nic̆ki vjesnik, 134 (11-12). pp. 322-7. ISSN 0024-3477

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Abstract

Total hip and knee arthroplasty is associated with significant perioperative blood loss, necessitating often blood transfusions. Because of risks and cost of allogenic blood transfusion and elective types of surgery several alternative methods have been developed to reduce allogenic blood use. We prospectively audited 65 consecutive patients undergoing primary total hip (THR; n = 30) or knee replacement (TKR; n = 35) at our Department of Orthopaedic Surgery which did not use autologous blood collection methods. Total blood loss in THR (1329.7 +/- 364.8 ml) and TKR (1427.3 +/- 660.4 ml) was similar to previously reported and without significant difference between the groups. However, we reported high transfusion rates with 63.3% of THR and 82.6% of TKR patients receiving allogenic blood. Important steps to reduce allogenic blood use would include implementation of restrictive transfusion protocols with a defined hemoglobin value as a transfusion trigger, correction of preoperative anemia with i.v. iron +/- erythropoietin, use of one or more modalities of autologous transfusion (postoperative autotransfusion, preoperative blood donation), pharmacological agents like tranexamic acid (anti-fibrinolytic) and other complementary procedures. There is sufficient evidence in literature about the cost-benefit of certain methods which makes routine use of allogenic blood in THR and TKR surgery unacceptable even at general orthopaedic surgery departments.

Abstract in Croatian

Operacije ugradnje totalnih endoproteza (TEP) kuka i koljena praćene su znatnim gubitkom krvi, što često zahtijeva transfuziju homologne (od davaoca) ili autologne (vlastite) krvi. S obzirom na rizike od transfuzije homologne krvi, cijenu krvnih pripravaka i elektivnu vrstu zahvata, u novije se vrijeme ističe važnost alternativnih postupaka kako bi se smanjila upotreba homologne krvi. U istraživanju smo prospektivno dokumentirali perioperacijski gubitak krvi i potrošnju krvnih pripravaka kod 65 konsekutivnih bolesnika podvrgnutih primarnim operacijama ugradnje TEP-a kuka (n=30) i koljena (n=35) u našoj ustanovi bez primjene metoda davanja autologne krvi. Ukupni gubitak krvi kod TEP-a kuka (1329,7±364,8 ml) i koljena (1427,3±660,4 ml) bio je u skladu s podacima u literaturi i bez značajne razlike između dvije skupine bolesnika. Međutim postotak bolesnika koji su primili homolognu krv (63,3% kod TEP-a kuka i 82,6% kod TEP-a koljena) bio je znatno veći nego kod sličnih bolesnika u novijim studijama. U radu su navedeni najvažniji postupci za smanjenje transfuzije homologne krvi koji uključuju protokol za perioperacijsko vođenje bolesnika, definiranje vrijednosti hemoglobina kao transfusion triggera, korekciju preoperacijske anemije intravenskim preparatima željeza, upotrebu jedne ili više metoda davanja autologne krvi, primjenu antifibrinolitika (traneksamična kiselina) i/ili druge komplementarne postupke. Na osnovi podataka o efikasnosti pojedinih metoda smatramo da rutinska upotreba krvnih produkata kod operacija TEP-a kuka i koljena nije opravdana ni izvan specijalnih ustanova i klinika za ortopediju.

Item Type: Article
MeSH: Aged ; Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Blood Transfusion, Autologous ; Erythrocyte Transfusion ; Female ; Humans ; Male
Departments: Katedra za anesteziologiju i reanimatologiju
Depositing User: Marijan Šember
Status: Published
Creators:
CreatorsEmail
Oberhofer, DagmarUNSPECIFIED
Šakić, KataUNSPECIFIED
Janković, SašaUNSPECIFIED
Tonković, DinkoUNSPECIFIED
Vrgoč, GoranUNSPECIFIED
Date: November 2012
Date Deposited: 11 Mar 2014 13:48
Last Modified: 11 Mar 2014 13:48
Subjects: /
Related URLs:
URI: http://medlib.mef.hr/id/eprint/2069

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