Reinfusion of postoperative wound drainage in total joint arthroplasty. Red blood cell survival and coagulopathy risk.
Fifty patients with total joint arthroplasties (28 total hip arthroplasties, 11 total knee arthroplasties, and 11 bilateral total knee arthroplasties) received autotransfusions from their postoperative wound drainage. The blood was collected in a closed sterile drainage system without any additional anticoagulant. Pre- and postoperative measurements were made of the patient's hemoglobin, platelets, fibrinogen, haptoglobin, fibrin degradation products, and D-dimer (a specific type of fibrin degradation product). Red blood cell survival was assessed in 16 of the patients by labeling the shed blood with 51Cr sodium chromate prior to reinfusion. To control for fluid shifts, continued bleeding, and dilution effects of further transfusions in the immediate postoperative period, 10 patients also had their native blood labeled with 111In oxime. In this study, the mean estimated blood loss was 1,062 mL (+/- 1,247) with a mean wound drainage of 836 mL (+/- 338). Of this, a mean of 450 mL (+/- 261) of blood was was given back to the patient in addition to routine, preoperative autologous donated blood. Six (12%) patients experienced transient fevers at the time of retransfusion. Detailed hematologic studies were performed on the shed blood in 19 patients. The collected blood was completely defibrinated, but did contain fibrin degradation products, as indicated by the D-dimer level, and hemolyzed blood as the haptoglobin was reduced. Even though the blood containing the above breakdown products was reinfused to the patients, there were no clinical manifestations of disseminated intravascular coagulation. Both the hemolyzed and defibrinated products were subsequently cleared by the body.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Orthopaedic Surgery, Northwestern University Medical School, Chicago, Illinois.
R L
RL
Wixson
H C
HC
Kwaan
S M
SM
Spies
A M
AM
Zimmer
D001779:Blood Coagulation Factors / Q000032:analysis; D016063:Blood Loss, Surgical; D001804:Blood Transfusion, Autologous / Q000009:adverse effects / Q000379:methods*; D001810:Blood Volume; D002860:Chromium Radioisotopes; D004211:Disseminated Intravascular Coagulation / Q000453:epidemiology*; D004322:Drainage / Q000295:instrumentation; D004905:Erythrocyte Aging; D005260:Female; D005334:Fever / Q000209:etiology; D006622:Hip Prosthesis; D006801:Humans; D007205:Indium Radioisotopes; D007720:Knee Prosthesis; D008297:Male; D012307:Risk Factors; D013997:Time Factors
D001779:Blood Coagulation Factors; D002860:Chromium Radioisotopes; D007205:Indium Radioisotopes