Hidden Blood Loss of Total Knee FVIII Prophylaxis in Hemophilia Arthritis : An Analysis of Influencing Factors

BackgroundTotal knee arthroplasty is the leading way to treat hemophilia arthritis. At present, there is a lack of research on the influencing factors of blood loss in total knee arthroplasty for hemophilia arthritis. This study comprehensively explores the definite factors affecting the hidden blood loss in total knee arthroplasty for hemophilia patients.Materials and methodsNinety-two hemophilia A patients who underwent total knee arthroplasty in our center were included. Demographic characteristics, laboratory data, surgical data, and complications were collected. The Gross equation and Sehat equation were used to calculate the estimated value of hidden blood loss. Multivariate stepwise linear regression analysis was used to determine the influencing factors of hidden blood loss.ResultThe hidden blood loss of hemophilia patients undergoing total knee arthroplasty was 1069.51±341.99mL, and the age was positively correlated with the hidden blood loss (P<0.001), while tranexamic acid, FVIII prophylaxis, and incremental invivo recovery were negatively correlated with the hidden blood loss (P<0.001, P=0.008, P=0.017).ConclusionElderly patients have a greater risk of blood loss, and additional preventive measures can be appropriately added. Intraoperative intra-articular injection of tranexamic acid is recommended to reduce hidden blood loss, FVIII prophylaxis is recommended for every patient. We recommend that all HA patients measure the incremental invivo recovery and develop a personalized coagulation factor infusion regimen.

[1]  Sualp Turan,et al.  Is tranexamic acid effective on hidden blood loss in patients during total knee arthroplasty? , 2020, Joint diseases and related surgery.

[2]  V. Vedi,et al.  Tourniquet and tranexamic acid use in total knee arthroplasty , 2020, Arthroplasty today.

[3]  E. Rodríguez‐Merchán.  The cost of hemophilia treatment: the importance of minimizing it without detriment to its quality , 2020, Expert review of hematology.

[4]  Zeyu Huang,et al.  Tranexamic acid may benefit patients undergoing total hip/knee arthroplasty because of haemophilia , 2019, BMC Musculoskeletal Disorders.

[5]  C. Hermans,et al.  Factor VIII: Long-established role in haemophilia A and emerging evidence beyond haemostasis. , 2019, Blood reviews.

[6]  R. Rodrigues-Pinto,et al.  Long-term results of total knee arthroplasty in hemophilic arthropathy , 2019, Journal of orthopaedic surgery.

[7]  Jun Xiao,et al.  Blood loss of total knee arthroplasty in osteoarthritis: an analysis of influential factors , 2018, Journal of Orthopaedic Surgery and Research.

[8]  D. Bae,et al.  Mid‐term outcomes and complications of total knee arthroplasty in haemophilic arthropathy: A review of consecutive 131 knees between 2006 and 2015 in a single institute , 2018, Haemophilia : the official journal of the World Federation of Hemophilia.

[9]  R. Yang,et al.  [Retrospectively analysis of the difference of bleeding frequency and hemophilic arthropathy between hemophilia A and hemophilia B patients]. , 2017, Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi.

[10]  B. Haghpanah,et al.  Functional outcome of total knee arthroplasty in patients with haemophilia , 2016, Haemophilia : the official journal of the World Federation of Hemophilia.

[11]  D. Allen,et al.  Meta‐analysis: outcomes of total knee arthroplasty in the haemophilia population , 2016, Haemophilia : the official journal of the World Federation of Hemophilia.

[12]  S. Keyhani,et al.  Which Route of Tranexamic Acid Administration is More Effective to Reduce Blood Loss Following Total Knee Arthroplasty? , 2016, The archives of bone and joint surgery.

[13]  G. Digas,et al.  Intra-articular injection of tranexamic acid reduce blood loss in cemented total knee arthroplasty , 2015, European Journal of Orthopaedic Surgery & Traumatology.

[14]  Y. Oymak,et al.  The Effectiveness of Tools for Monitoring Hemophilic Arthropathy , 2015, Journal of pediatric hematology/oncology.

[15]  Rebecca R. Miller.  Total , 2014, Definitions.

[16]  J. Mahlangu,et al.  Guidelines for the management of hemophilia , 2013, Haemophilia : the official journal of the World Federation of Hemophilia.

[17]  P. Monagle,et al.  Association between physical activity and risk of bleeding in children with hemophilia. , 2012, JAMA.

[18]  A. Shapiro,et al.  Modern haemophilia care , 2012, The Lancet.

[19]  Christine A. Lee,et al.  Transfusion-transmitted infection in hemophilia in developing countries. , 2005, Seminars in thrombosis and hemostasis.

[20]  E. Rodríguez‐Merchán,et al.  Total knee arthroplasty in HIV‐positive haemophilic patients , 2002, Haemophilia : the official journal of the World Federation of Hemophilia.

[21]  J. Duguid,et al.  Guidelines for the clinical use of red cell transfusions , 2001, British journal of haematology.

[22]  Evans,et al.  How much blood is really lost in total knee arthroplasty?. Correct blood loss management should take hidden loss into account. , 2000, The Knee.

[23]  M. Neo,et al.  Reduction of blood loss using tranexamic acid in total knee and hip arthroplasties , 2000, Archives of Orthopaedic and Trauma Surgery.

[24]  J B Gross,et al.  Estimating allowable blood loss: corrected for dilution. , 1983, Anesthesiology.