title: Intravenous iron supplementation with intra-articular administration of tranexamic acid reduces the rate of allogeneic transfusions after simultaneous bilateral total knee arthroplasty.
abstract: BACKGROUND
  Peri-operative intravenous administration of iron supplementation seems a good option to reduce allogeneic blood transfusion in major orthopaedic surgery. However, its efficacy in simultaneous bilateral total knee arthroplasty has not been studied.
  
  
  METHODS
  From December 2014 to May 2015, a total of 72 consecutive patients underwent simultaneous bilateral total knee arthroplasty and received peri-operative intravenous iron supplementation (iron isomaltoside 1000: 600 mg pre-operatively and 400 mg 1 week post-operatively) and intra-articular tranexamic acid (2 g in 20 mL saline at the end of surgery), and were managed with a restrictive transfusion trigger (haemoglobin <7 g/dL). Post-operatively, we observed patients closely for symptoms of anaemia and checked their haemoglobin levels on days 1, 6 and 13 after surgery.
  
  
  RESULTS
  The mean baseline haemoglobin level was 13.1 g/dL. The levels remained above 7.0 g/dL on post-operative days 1, 6 and 13 (mean, 11.4 g/dL, 9.9 g/dL and 10.4 g/dL, respectively) in all but one patient who experienced melaena and required allogeneic blood transfusion.
  
  
  CONCLUSIONS
  Intravenous iron supplementation combined with intra-articular administration of tranexamic acid seems to be an effective strategy for reducing the rate of allogeneic blood transfusion in patients undergoing simultaneous bilateral total knee arthroplasty managed with a restrictive transfusion trigger.
authors.affiliation: Joint Centre Barunsesang Hospital, Gyeonggi-do, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
authors.forename: Dong Won
authors.initials: DW
authors.lastname: Suh
authors.affiliation: Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
authors.forename: Seung-Beom
authors.initials: SB
authors.lastname: Han
authors.affiliation: Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
authors.forename: Jong-Hoon
authors.initials: JH
authors.lastname: Park
authors.affiliation: Joint Centre Barunsesang Hospital, Gyeonggi-do, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
authors.forename: Kuhoang
authors.initials: K
authors.lastname: Cheong
authors.affiliation: Joint Centre Barunsesang Hospital, Gyeonggi-do, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
authors.forename: Bong Soo
authors.initials: BS
authors.lastname: Kyung
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000517:prevention & control; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee; D001803:Blood Transfusion; D004187:Disaccharides / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D006397:Hematinics / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D004187:Disaccharides; D005290:Ferric Compounds; D006397:Hematinics; C557707:iron isomaltoside 1000; D014148:Tranexamic Acid