Replacement for intraoperative blood loss

Abstract

Twenty seven patients less than 70 yr old were studied while undergoing elective total hip arthroplasty under the care of one of 3 surgical teams. The patients had no significant cardiorespiratory disease, and their hemoglobin concentrations preoperatively were normal. The authors randomly assigned the fluids used for initial replacement from a balanced block design so that 3 patients from each service received each of the 3 replacements: whole blood, plasma, and dextran 75. Blood loss in the dextran group was nearly twice that experienced in the blood replacement group. The authors were unable to discern any cause for this increased bleeding associated with the surgical dissection, complicated pathology, abnormal blood clotting tests, or gross prolongation of operative time. This supports the impression of the surgeons that dextran replacement tends to increase operative oozing. The difference in blood loss was statistically significant. In addition to losing more blood, this group experienced a greater decrease in hemoglobin concentration, 5.6 g/100 ml on the average, in spite of receiving almost the same amount of transfused blood in the total perioperative period. Four of the patients require blood intraoperatively, and one of these and 3 others required blood postoperatively. The estimated blood loss in the plasma replacement group was intermediate between the losses in the blood and dextran groups and not significantly different from either. The average decrease in hemoglobin was also intermediate Four patients received no blood at all. Three others had but a single transfusion. One case presented operative difficulties to the surgeon, resulting in a measured loss of 5 liters of blood which was replaced with 7 units of blood after 1,750 ml of plasma protein fractions.