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Overview :
Grosflam et al identified factors which can be used to
identify a patient who is more likely to lose blood during an elective total
hip replacement. These can help identify a patient who may wish to donate
additional units of autologous blood. The authors are from Brigham and Women's
Hospital in Boston.
Patient selection:
(1) elective
cases >= 16 years of age
(2) exclusions:
HIV, transplant, chemotherapy, metastastic cancer, major surgery within
previous 6 weeks
(3) while not
an exclusion criterion, no patients were ASA classes IV or V
The mean blood loss was 3.6 units, with the mean blood
replacement 2 units. Blood loss was estimated by the difference in pre and
postoperative hematocrits (divided by 3) and the total number of units
transfused.
Risk factors for increased blood loss:
(1) male gender
(2) ASA class III
(3) general anesthesia
where:
• Comorbid
conditions other than hypertension were infrequent.
• The method
for estimating blood loss is subject to hemodilution from crystalloid infusion
during surgery.
• Some
surgeries were performed by residents and fellows in training, which was
controlled for.
• Most of the
replacements were done for osteoarthritis (71%) or rheumatoid arthritis (17%).
• 60% of the
patients had the procedure done under local anesthesia only. 16% had general
only and 24% had local plus general anesthesia (Table 2, page 169).
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