title: Total hip arthroplasty in patients with haemophilia - What are the risks of bleeding in the immediate peri-operative period?
abstract: BACKGROUND
  Undergoing a major surgical intervention such as total hip arthroplasty (THA) with an underlying clotting disorder like haemophilia poses its own unique challenges. Despite the advances in factor replacement and medical management, the potential for excessive and uncontrolled haemorrhage still exists. The aim of this study was to quantify blood loss, peri-operative transfusion requirements and risk of haematoma formation in a cohort of patients with haemophilia undergoing THA.
  
  
  METHODS
  All patients with haemophilia types A or B who had undergone THA in the previous 10 years were identified from the Hospital In-Patient Enquiry system and theatre logs. A comprehensive review of operative records, laboratory parameters and peri-operative haematological management was conducted.
  
  
  RESULTS
  Eleven male patients (12 THA) were identified. The mean age was 56 years (range 28-76). The mean intra-operative blood loss was 502 ml (100-1250 ml) compared to an established normal blood loss of 400 ml. The mean drop in haemoglobin was 3.25 g/dl in 48 h. Only one patient required a post-operative transfusion of two units of red cell concentrate. There were no complications of haematoma formation.
  
  
  CONCLUSIONS
  The results in our institution compare favourably with the established blood loss reported in the literature and by assessment with International Guidelines. Average blood loss in patients with haemophilia was higher than the established normal, but there was no increased transfusion requirement.
authors: Department of Orthopaedic Surgery, St James Hospital, Dublin 8, Ireland.
authors: Grainne
authors: G
authors: Colgan
authors: Department of Orthopaedic Surgery, St James Hospital, Dublin 8, Ireland.
authors: Joseph F
authors: JF
authors: Baker
authors: Department of Orthopaedic Surgery, St James Hospital, Dublin 8, Ireland.
authors: N
authors: N
authors: Donlon
authors: Department of Orthopaedic Surgery, St James Hospital, Dublin 8, Ireland.
authors: N
authors: N
authors: Hogan
authors: Department of Orthopaedic Surgery, St James Hospital, Dublin 8, Ireland.
authors: T
authors: T
authors: McCarthy
keywords: Bleeding Risk; Haemophilia; Hip Arthroplasty; Transfusion