Blood Loss In Orthopedic Surgery Research Articles

Use of antifibrinolytic therapy in orthopedic surgery: a review

Total joint arthroplasties, trauma, and spine surgery are correlated with a significant amount of bleeding. The severity of the bleeding might be substantial enough to require a blood transfusion to treat the resulting anemia. Antifibrinolytic therapy is used to reduce blood loss in orthopedic surgery. This review aimed to assess the recent research supporting the use of antifibrinolytic therapy to reduce blood loss in orthopedic surgery. In the last 10 years, the published studies determining antifibrinolytic therapy's effect on orthopedic surgery were searched in Google Scholar and PubMed. Antifibrinolytic agents are used in most surgical operations, including orthopedic surgery. It causes a significant reduction in blood loss and blood transfusion. In addition, antifibrinolytic therapy did not increase the risk of deep vein thrombosis in patients undergoing total joint arthroplasty. Tranexamic acid, epsilon aminocaproic acid, and aprotinin are the most popular fibrinolytic agents. Tranexamic acid is more frequently used in patients undergoing joint replacement, spine and trauma surgery. . Although aminocaproic acid has a more limited history of usage in orthopedic surgery than tranexamic acid, it has a more significant antifibrinolytic effect.

Enhanced recovery after surgery (ERAS) protocol in geriatric patients underwent unicompartmental knee arthroplasty: A retrospective cohort study.

The enhanced recovery after surgery (ERAS) pathway was formulated with the aim to reduce surgical stress response, alleviate pain and guarantee the best-fit experience of patients' perioperative period. However, the application of ERAS in geriatric patients who underwent unicompartmental knee arthroplasty (UKA) was relatively lacking. We hypothesize that UKA patients can benefit from the ERAS protocol. A total of 238 patients were recruited in this retrospective study from August 2018 to December 2021, and Oxford phase III UKA was applied to all patients. ERAS pathway included nutrition support, anesthesia mode, interoperative temperature, and blood pressure control, application of tranexamic acid, early initiation of oral intake and mobilization, and pain management. Demographic data, operation-relative variables, and postoperative complications were analyzed. Forgotten Joint Scores, Oxford Knee Score, Lysholm score, numerical rating scale, and knee range of motion were introduced to estimate the activity function and pain of surgical knee, and these variables were compared between the 2 groups. There were 117 patients in the ERAS group and 121 patients in the traditional group, respectively. The ERAS group had a shorter length of surgical incision and less intraoperative blood loss. Postoperative hemoglobin and albumin of patients in the ERAS group were better than those in the traditional group (P < .05), after 17.0 ± 10.8 months follow-up, the numerical rating scale, Lysholm, Oxford Knee Score, Forgotten Joint Scores, and knee range of motion of patients in the ERAS group were significantly better than the traditional group. The length of hospital stay for patients who underwent ERAS was 11.7 ± 3.8 days and the postoperative complication rate was lower for the ERAS group patients (P = .000 and 0.031). ERAS can reduce the length of hospital stay, and patients can achieve excellent postoperative knee function. The formulation and implementation of the ERAS protocol require good collaboration across multiple disciplines, as well as a deep understanding of the existing clinical evidence and the concept of the ERAS program.

Randomized, controlled trial of two tranexamic acid dosing protocols in adult spinal deformity surgery.

Tranexamic acid (TXA) is an anti-fibrinolytic effective in reducing blood loss in orthopedic surgery. The appropriate dosing protocol for adult spinal deformity (ASD) surgery is not known. The purpose of this study was to evaluate two TXA protocols [low dose (L): 10mg/kg bolus, 1mg/kg/hr infusion; high dose (H): 50mg/kg, 5mg/kg/hr] in complex ASD surgery. Inclusion criteria were ASD reconstructions with minimum 10 fusion levels or planned 3-column osteotomy (3CO). Standard demographic and surgical data were collected. Intraoperative estimated blood loss (EBL) was calculated by suction canisters minus irrigation plus estimated blood lost in sponges, estimated to the nearest 50mL. Serious adverse events (SAE) were defined a priori as: venothromboembolic event (VTE), cardiac arrhythmia, myocardial infarction, renal dysfunction, and seizure. All SAE were recorded. Simple t tests compared EBL between groups. Mean EBL by total blood volume (TBV), transfusion volume, complications related to TXA were secondary outcomes. Sixty-two patients were enrolled and 52 patients completed the study; 25 were randomized to H and 27 to L. Demographic and surgical variables were not different between the two groups. EBL was not different between groups (H: 1596 ± 933cc, L: 2046 ± 1105cc, p = 0.12, 95% CI: -1022 to 122cc). EBL as a percentage of TBV was lower for the high-dose group (H: 29.5 ± 14.8%, L: 42.5 ± 26.2%, p = 0.03). Intraoperative transfusion volume (H: 961 ± 505cc, L: 1105 ± 808cc, p = 0.5) and post-operative transfusion volume (H: 513 ± 305cc, L: 524 ± 245cc, p = 0.9) were not different. SAE related to TXA were not different (p = 0.7) and occurred in 2 (8%) H and 3 (11%) L. There was one seizure (H), 2 VTE, and 2 arrhythmias. No differences in EBL, transfusion volume, nor SAE were observed between H and L dose TXA protocols. High dose was associated with decreased TBV loss (13%). Further prospective study, with pharmacologic analysis, is required to determine appropriate TXA dosage in ASD surgeries. Therapeutic Level II. The study was registered at Clinicaltrials.gov (NCT02053363) February 3, 2014.

Utilization of Tranexamic Acid in Surgical Orthopaedic Practice: Indications and Current Considerations.

Tranexamic acid (TXA) is a lysine analog that exhibits an anti-fibrinolytic effect by directly preventing the activation of plasminogen as well as inhibiting activated plasmin from degrading fibrin clots, thereby promoting hemostasis and reducing the duration and quantity of blood loss. The aims of this study were to summarize the indications, routes of administration, safety, and clinical outcomes of TXA use throughout the different subspecialities in orthopedic surgery. Given that orthopedic procedures such as TKA, THA, fracture fixation, and various spine surgeries involve significant intraoperative blood loss, TXA is indicated in providing effective perioperative hemostasis. Additionally, use of TXA in orthopedic trauma has been indicated as a measure to reduce blood loss especially in a group with potential for hemodynamic compromise. TXA has been implicated in reducing the risk of blood transfusions in orthopedic trauma, joint surgery, and spine surgery, although this effect is not seen as prominently in sports medicine procedures. There remains disagreement in literature as to whether TXA via any route of administration can improve other clinically significant outcomes such as hospital length of stay and total operative time. Procedures that rely extensively on clarity on visualization of the surgical field such as knee and shoulder arthroscopies can greatly benefit from the use of TXA, thereby leading to less intraoperative bleeding, with better visual clarity of the surgical field. While most studies agree thrombosis due to TXA is unlikely, new research in cells and animal models are evaluating whether TXA can negatively impact other aspects of musculoskeletal physiology, however with conflicting results thus far. As of now, TXA remains a safe and effective means of promoting hemostasis and reducing intraoperative blood loss in orthopedic surgery.

Safety and Effectiveness of the Topical Application of Tranexamic Acid to Reduce Drainage of Elderly Femoral Neck Fractures After Total Hip Arthroplasty: An observational pilot study

Background: There is a common disease of femoral neck fractures in elderly patients. And the incidence of postoperative wound bleeding and hyperfibrinolysis is very high. Tranexamic acid (TXA) has a certain effect in decreasing blood loss in orthopaedic surgery. A randomized controlled trial will assess the safety and effectiveness of TXA in decreasing drainage of elderly femoral neck fractures after total hip arthroplasty. Methods: 144 elderly femoral neck fractures are randomly and evenly divided into experimental group and control group, the experimental group receives 3g of infused retrogradely into the drainage tube tranexamic acid mixed in 100ml of saline after the operation and the control group receives an equivalent volume bolus of saline-infused retrogradely into the drainage after the operation. Observation indicators include drainage volume, total drainage volume, and the postoperative hemoglobin loss on the 1st, 2nd, and 3rd day after operation, postoperative wound healing, cardiovascular and cerebrovascular events, and pulmonary embolism, etc. Data analysis was performed using SPSS 25.0 software and GraphPad InStat. Results: The estimated drainage volume was significantly lower in the experimental group than control group on the first day after operation and the second day after operation (p &lt;0.05). And the hemoglobin and hematocrit levels on the first day after operation, the second day after operation, and the third day after operation in the experimental group were higher than those in the control group (P &lt; 0.05). Moreover, there was no significant difference in coagulation function between the two groups, and a lack of significant intergroup differences in the postoperative complications, such as the incidences of deep vein thrombosis, pulmonary embolism, myocardial infarction, reoperation, and readmission or in terms of mortality rates. Conclusion: This clinical study demonstrated that topical application of TXA administration safely reduced drainage and blood loss without affecting the coagulation function for elderly femoral neck fractures after total hip arthroplasty. Abbreviations: TXA=Tranexamic acid; PE=Pulmonary embolism; DVT=Deep vein thrombosis; BMI=Body mass index; MI=Miocardial infarction.

Tranexamic Acid Administration is Associated With a Decreased Odds of Prosthetic Joint Infection Following Primary Total Hip and Primary Total Knee Arthroplasty: A National Database Analysis

BackgroundTranexamic acid (TXA) for the reduction of blood loss in orthopedic surgery is coming into greater adoption. Because TXA administration lowers the incidence of blood transfusion and of hematoma formation, risk factors for infection, we asked whether TXA use might be associated with a lower incidence of periprosthetic joint infection (PJI) following orthopedic surgery. MethodsWe queried the Premier Healthcare database for ICD-9 codes corresponding to elective inpatient primary total hip replacement (THR) or total knee replacement (TKR) from 2012 to 2016, TXA administration on the day of surgery, and PJI during the hospital stay or within 90 days. We performed a multilevel multivariable logistic regression (SAS version 9.4. SAS Institute, Cary, NC) to determine if TXA administration or other covariates were a significant predictor of infection. ResultsAmong 914,990 total joint arthroplasty patients, 46.0% received TXA on the day of surgery. 0.13% developed PJI within 90 days. After adjusting for patient and hospital-related covariates, TXA use was associated with significantly lower odds of PJI within 90 days of surgery (OR 0.49 [0.69, 0.91]). ConclusionAdministration of TXA on the day of surgery in total knee and total hip arthroplasty was associated with a statistically significant decreased odds of PJI in the first 90 days. We therefore conclude that TXA might play an important role in our attempts to decrease PJI after joint arthroplasty. The exact mechanisms and ideal dosage by which TXA can contribute to such a reduction need further study.

Randomized prospective evaluation of the use of tranexamic acid and effects on blood loss for proximal humeral fracture surgery

Tranexamic acid (TXA) is an antifibrinolytic agent that has been used to reduce blood loss in orthopedic surgery. It has been shown to decrease blood loss in upper- and lower-extremity arthroplasty, as well as lower-extremity fracture surgery. The use of TXA for proximal humeral fracture surgery has yet to be evaluated. The purpose of this study was to examine the effects of TXA on blood loss in patients undergoing open reduction-internal fixation (ORIF) or arthroplasty for the treatment of proximal humeral fractures. A total of 101 patients were randomized to receive either a single preoperative dose of intravenous TXA (53 patients) or a control dose of saline solution (48 patients) at the time of proximal humeral fracture surgery. On the basis of patient age and fracture pattern, ORIF was performed in 57 patients (30 TXA and 27 control patients) and reverse shoulder arthroplasty (RSA) was performed in the other 44 patients (23 TXA and 21 control patients). Intraoperative blood loss plus 24-hour drain output was used to calculate total blood loss for each procedure. The preoperative-to-postoperative change in hemoglobin level was also evaluated for each patient. Further stratification of blood loss and change in hemoglobin level based on procedure (ORIF or RSA) was performed as well. Compared with the control group, the TXA group had less average intraoperative blood loss (178 mL vs. 129 mL, P < .0001), less postoperative drain output (103 mL vs. 62 mL, P < .0001), and less total blood loss (280 mL vs. 188 mL, P < .0001). Compared with the control group, the TXA group had a smaller average preoperative-to-postoperative change in hemoglobin level(-2.6 g/dL vs. -1.5 g/dL, P < .0001). Further stratification based on procedure showed that among patients undergoing ORIF and patients undergoing RSA, those receiving TXA had less average total blood loss and a smaller decrease in hemoglobin level than the control group. No identifiable intraoperative or postoperative complications associated with the use of TXA occurred in any patient. TXA was effective in reducing total blood loss and led to a smaller preoperative-to-postoperative decrease in hemoglobin levelcompared with control in patients undergoing surgery for proximal humeral fractures. This effect was consistent in patients treated with either ORIF or arthroplasty as the surgical procedure. TXA can be used to decrease blood loss in the surgical treatment of proximal humeral fractures.

Safety of Tranexamic Acid: Are Precautions Needed?

There are a numerous approaches to limit blood loss in orthopedic surgery, including meticulous surgical technique and hemostasis, use of tourniquets, hypotensive anesthesia, and pharmacologic methods such as tranexamic acid (TXA). TXA is an antifibrinolytic drug that has been found to effectively treat several bleeding-related conditions. It has also been used widely among surgical subspecialties because of its effects on hemostasis and ability to reduce transfusion rates. TXA is positively transforming blood management practices with respect to orthopedic surgery. The use of TXA in orthopedic surgery remains off-label use despite the numerous studies demonstrating the benefits of TXA in orthopedic patients. However, there are concerns over potential risks associated with the use of an antifibrinolytic agent during orthopedic surgery because of the inherent risk of thromboembolic events in the perioperative period. In this article, we review the use and safety of TXA in orthopedic surgery to guide clinical practice and blood product management. Complications and evidence for the contraindications of TXA administration are also examined to provide a clear picture of the risks and benefits of using TXA in orthopedic surgery patients.

Blood Loss in Orthopedic Surgery: A Historical Review

Joint arthroplasty since its inception has been associated with substantial blood loss and this blood loss has led to high allogenic transfusion rates as well as the development of hemarthrosis. Once hemarthrosis occurs, joint infection, wound complications, and increased recovery time also occur. The administration of allogenic blood products is not without risk and has been associated with incorrect blood crossmatching, transmission of both bacterial and viral pathogens, anaphylactic reactions, immunosuppression, and fluid overload. Postoperative anemia coupled with the resulting increase in transfusion requirements increases morbidity, mortality, length of hospital stay as well as overall health care costs. These factors have driven orthopedic surgeons to modify existing technology as well as propose new devices and protocols in an effort to maximize positive outcomes for their patients. The result is a robust, multimodal approach to blood conservation which is constantly changing and improving. This article chronicles the history of blood conservation techniques, analyzes their advantages and disadvantages and brings to light the cutting edge technology which modern medicine has produced to combat this problem.

High-dose tranexamic acid reduces intraoperative and postoperative blood loss in posterior lumbar interbody fusion.

OBJECTIVE Tranexamic acid (TXA), a synthetic antifibrinolytic drug, has been reported to reduce blood loss in orthopedic surgery, but there have been few reports of its use in spine surgery. Previous studies included limitations in terms of different TXA dose regimens, different levels and numbers of fused segments, and different surgical techniques. Therefore, the authors decided to strictly limit TXA dose regimens, surgical techniques, and fused segments in this study. There have been no reports of using TXA for prevention of intraoperative and postoperative blood loss in posterior lumbar interbody fusion (PLIF). The purpose of the study was to evaluate the efficacy of high-dose TXA in reducing blood loss and its safety during single-level PLIF. METHODS The study was a nonrandomized, case-controlled trial. Sixty consecutive patients underwent single-level PLIF at a single institution. The first 30 patients did not receive TXA. The next 30 patients received 2000 mg of intravenous TXA 15 minutes before the skin incision was performed and received the same dose again 16 hours after the surgery. Intra- and postoperative blood loss was compared between the groups. RESULTS There were no statistically significant differences in preoperative parameters of age, sex, body mass index, preoperative diagnosis, or operating time. The TXA group experienced significantly less intraoperative blood loss (mean 253 ml) compared with the control group (mean 415 ml; p < 0.01). The TXA group also had significantly less postoperative blood loss over 40 hours (mean 321 ml) compared with the control group (mean 668 ml; p < 0.01). Total blood loss in the TXA group (mean 574 ml) was significantly lower than in the control group (mean 1080 ml; p < 0.01). From 2 hours to 40 hours, postoperative blood loss in the TXA group was consistently significantly lower. There were no perioperative complications, including thromboembolic events. CONCLUSIONS High-dose TXA significantly reduced both intra- and postoperative blood loss without causing any complications during or after single-level PLIF.

Determination of the efficacy of EVICEL™ on blood loss in orthopaedic surgery after total knee replacement: study protocol for a randomised controlled trial.

BackgroundAfter total knee replacement, overall blood loss is often underestimated, although it exceeds the visible blood loss caused by bleeding into the tissues or into the joint. The use of fibrin sealants during surgery has been suggested to reduce perioperative blood loss and transfusion rates and may be beneficial for patient recovery and the postoperative function of the joint.Methods/DesignThis will be a single-centre, single-blinded, randomised controlled trial with a parallel design, for which 68 patients undergoing total knee replacement will be recruited and followed up at 3, 6 and 12 months; 34 will be control patients who will receive the standard orthopaedic surgery treatment (electrocoagulation), and the other 34 will receive the same treatment plus 5 ml EVICEL™ applied during surgery and used according to the manufacturer’s instructions. The primary objective is to test the null hypothesis that the effect of EVICEL™ for controlling haemostasis and reducing postoperative blood loss in patients undergoing total knee replacement is not superior to the use of electrocoagulation alone. The secondary objective is to show that EVICEL™ reduces the need for transfusion, increases range of motion, improves clinical outcome and wound healing, and reduces the need for analgesics. The tertiary objective is to show that EVICEL™ reduces the costs of total knee replacement treatment.DiscussionSo far, studies on the effect of fibrin sealants in total knee replacement have delivered inconsistent and ambivalent results, indicating that there is still a need for high-evidence studies as proposed in the presented study protocol.Trial registrationGerman registration number DRKS00007564; date of registration: 26 November 2014.

Tranexamic Acid Reduces Blood Transfusion, Postoperative Blood Loss

Total knee arthroplasty usually has an important blood loss which may lead patients to receive allogeneic blood transfusion up to 30-45% of cases. Allogeneic blood transfusion is not free of risks, like disease transmission, ABO incompatibility, transfusion-related lung injury, fluid overload and increased procedure costs. Blood saving strategies should be implemented in surgical patients with known blood loss procedures in order to reduce allogeneic blood transfusion risk. Prophylactic use of the anti-fibrinolytic drug tranexamic acid (TXA) is useful in preventing blood loss in orthopedic surgery. In this study, 90 unilateral total knee arthroplasty with prophylactic use us TXA were compared to 60 historical cases. Patients in both groups underwent total knee arthroplasty with the same surgical technique and the same surgeon team. TXA was administered in 2 doses of 10-15 mg/kg to those patients with no contraindications, 15 minutes before ischemia release and 3 hours later. In the TXA series, there was a reduced transfusion requirements from 0.85 PRBC/patient to 0, 35 PRBC/patient (p=0.0031), and a risk reduction of 41, 17% (RR 0.56, IC95% 0.35-0.88). Visible bleeding in 24 h significantly decreased from 540 cc (IC95% 393-687) to 168 cc (IC95% 130-207) in the TXA series (p<0.0001), and a reduced length of hospital stay from 8.92 days to 7.09 days in the TXA series (p=0.03). As a conclusion, implementing a blood saving strategy based on TXA in orthopaedic patients is effective and reduces risk of allogeneic blood transfusion.

Preoperative use of epoietin beta in total hip replacement: a prospective study

Epoietin (EPO) effectively decreases perioperative blood transfusion requirements. We evaluated the feasibility of using EPO beta to increase haemoglobin levels before total hip replacement (THR) and reduce transfusion. One hundred and seventy-one patients undergoing primary THR were included in this prospective observational study. Patients with initial haemoglobin level <130 g l−1 received EPO beta subcutaneously in a four-dose regimen. Haemoglobin levels were measured at baseline, before surgery, and at postoperative days 1 and 5. Twenty-eight patients received EPO beta preoperatively, 143 were not treated including 42 with initial haemoglobin level <130 g l−1. Haemoglobin increased by 29 ± 9 g l−1 in the low Hb + EPO group versus 2 ± 1 g l−1 for the other patients. In the low Hb + EPO group 3.6% were transfused, in the low HB group 45.2% (P = 0.001) and in the normal Hb group 11.9% (P = 0.2). Preoperative EPO beta increases haemoglobin level and reduces transfusion frequency in anaemic patients before total joint replacement. It could play a major role in the management of perioperative blood loss in orthopaedic surgery.

Do Antifibrinolytics Reduce Allogeneic Blood Transfusion in Orthopedic Surgery?

Studies have shown that antifibrinolytic (aprotinin, tranexamic acid, epsilon-aminocaproic acid) reduce blood loss in orthopedic surgery. However, most lacked sufficient power to evaluate the efficacy and safety on clinical outcomes. This meta-analysis aims to evaluate whether intravenous antifibrinolytics, when compared with placebo, reduce perioperative allogeneic erythrocyte transfusion requirement in adults undergoing orthopedic surgery and whether it might increase the risk of venous thromboembolism. From MEDLINE, EMBASE, and the Cochrane Controlled Trials Register, the authors identified 43 randomized controlled trials in total hip and knee arthroplasty, spine fusion, musculoskeletal sepsis, or tumor surgery performed to July 2005 (for aprotinin, 23 trials with 1,268 participants; tranexamic acid, 20 with 1,084; epsilon-aminocaproic acid, 4 with 171). Aprotinin and tranexamic acid reduced significantly the proportion of patients requiring allogeneic erythrocyte transfusion according to a transfusion protocol. The odds ratio was 0.43 (95% confidence interval, 0.28-0.64) for aprotinin and 0.17 (0.11-0.24) for tranexamic acid. Results suggest a dose-effect relation with tranexamic acid. Epsilon-aminocaproic acid was not efficacious. Unfortunately, data were too limited for any conclusions regarding safety. Although the results suggest that aprotinin and tranexamic acid significantly reduce allogeneic erythrocyte transfusion, further evaluation of safety is required before recommending the use of antifibrinolytics in orthopedic surgery.

Transfusion avoidance in orthopedic surgery

BLOOD LOSS IN orthopedic surgery has not always been well understood. In the late 1980s, it was thought that factors that contributed to patients receiving allogeneic transfusion included excessive blood loss at the time of surgery or a hemolytic or redistribution process.1 It was Berman et al2 in 1988 who first reported the importance of the preoperative hemoglobin and hematocrit. At the time that article was written, 50% of the patients received an allogeneic transfusion. What was interesting in this study was that there was no difference in blood loss between those who received the transfusion and those who did not. The preoperative hemoglobin and hematocrit were the most important factors in determining those who received an allogeneic transfusion.

Minimizing Perioperative Blood Loss in Orthopedic Surgery

Minimizing Perioperative Blood Loss in Orthopedic Surgery

Strategies for minimizing blood loss in orthopedic surgery

Several major orthopedic surgical procedures including hip arthroplasty, femoral osteotomy, and spinal fusion may result in significant blood loss and the need for allogeneic blood transfusions. Due to the heightened awareness of the potential deleterious effects of allogeneic blood product administration, several techniques have been evaluated to determine their efficacy in limiting perioperative blood loss. The following article will discuss the options to limit the need for allogeneic blood product administration during orthopedic surgical procedures. These techniques include: general considerations, autologous transfusion therapy, intraoperative and postoperative blood salvage, pharmacologic manipulation of the coagulation cascade, and controlled hypotension. Undoubtedly, many of these techniques are effective alone; however, the goal of performing major orthopedic surgical procedures without the use of allogeneic blood products can only be accomplished by combining several of these techniques.

The use of the orthopaedic perioperative autotransfusion (OrthoPAT) system in total joint replacement surgery.

Management of blood loss in orthopaedic surgery has evolved over the years. New approaches to making blood safer for patients has involved the use of preoperative autologous donation, the use of epoetin alfa administered preoperatively, intraoperative salvage, and perioperative salvage and infusion devices. A new alternative to salvage and infusion devices is the OrthoPAT. This article is meant to introduce the device to the orthopaedic nurse who works in the OR, PACU, and orthopaedic or medical-surgical unit, and who cares for orthopaedic patients who experience significant blood loss in total joint replacement surgery.

Is There Any Influence of the Protein C System on Perioperative Blood Loss in Total Knee or Hip Arthroplasty?

In modern surgery one main goal is to reduce perioperative transfusion need (e.g., modern surgical techniques, preoperative haemodilution, substitution of coagulation factors, autotransfusion). Besides haemostatic disorders, the patients' gender and the fact of osteoarthrosis-induced surgery turned out to be significant predictors of blood loss in orthopaedic surgery [1]. A precise prediction of blood loss for each patient would permit development of rational autologous blood donation or other blood conservation strategies, and thus reduce the need for allogeneic blood transfusions. An association of the Factor V Leiden (FV Q506) mutation—an hereditary defect of the protein C system—with a lower rate of intrapartum haemorrhage and reduced intrapartum blood loss has recently been reported [2,3]. Therefore, we examined the protein C system for an association with the perioperative blood loss in orthopaedic patients. The capacity of the protein C pathway can be assessed by the ProC Global (PCgl) assay. The assay is mainly influenced by protein C, protein S, activated protein C resistance (i.e., the FV Q506 mutation) and by factor VIII-levels [4].

A.179 Correlation between preoperative haematocrit and intraoperative blood loss in orthopaedic surgery

A.179 Correlation between preoperative haematocrit and intraoperative blood loss in orthopaedic surgery