The evaluation of blood loss after tranexamic acid application in a Jehovah's Witness undergoing hip replacement surgery: Case report

Year 2015, Volume: 7 Issue: 1, 1 - 3, 01.04.2015

Özgür Şentürk Yeşim Macit Selçuk Şimşek Faik Murat Ünsal Mehmet Nurullah Ermiş Can Solakoğlu

Abstract

There are several studies showing that tranexamic acid has been used effectively in total hip replacement surgery and knee arthroplasty in order to decrease blood loss and the need for allogenic blood transfusion. In this report we evaluated the effect of tranexamic acid on perioperative bleeding in a Jehovah's Witness who rejects allogeneic and autologous blood transfusion due to her religious beliefs. A 72-year-old, ASA II, female Jehovah's Witness was planned to undergo total hip replacement surgery due to right coxarthrosis. In the preoperative evaluation Hb was 13.3 mg/dl. The patient stated that she does not accept the allogeneic and autologous blood transfusion, but only did not reject the usage of the cell saver method. Patient underwent spinal anesthesia and cell saver method was prepared for use. Tranexamic acid at a dose of 10 mg/ kg was administered in 100 ml saline as 30 minute infusion, just before the first surgical incision. Three hours after the initial dose, tranexamic acid infusion was repeated at a dose of 2 mg/kg. Total surgical time was 100 minutes and total blood loss was 150 mL. The patient did not require blood transfusion. He was discharged on the 5th day postoperatively. Intraoperatively used tranexamic acid was found to reduce blood loss and blood transfusion requirements, in total hip replacement surgery.

Keywords

Tranexamic acid, total hip arthroplasty, Jehovah's Witness

Total kalça protezi yapilan bir Yehova Şahidi'nde traneksamik asidin kan kaybı üzerine etkisinin değerlendirilmesi Olgu sunumu

Abstract

Traneksamik asidin total kalça ve diz protezlerinde kullanımı ile, kan kaybının ve allojenik kan transfüzyonu gereksiniminin azaldığı birçok çalışma ile gösterilmiştir. Dini inanış gereği allojenik ve otolog kan transfüzyonunu reddeden Yehova şahidinde traneksamik asidin peroperatif kanama üzerine etkileri değerlendirildi. 72 yaşında, ASA II Yehova şahidi olan hastaya sağ koksartroz nedeniyle total kalça protezi planlandı. Preoperatif değerlendirilmesinde Hb:13,3 mg/dl idi. Hasta allojenik ve otolog kan transfüzyonunu kabul etmediğini, ancak “cell saver” yöntemini kullanabileceğimizi bildirdi. Hastaya spinal anestezi uygulandı ve cell saver yöntemi kullanıma hazırlandı. Cerrahi ilk insizyondan yarım saat önce 10 mg/kg Traneksamik asid infüzyonu yapıldı. İlk dozdan 3 saat sonra 2 mg/kg traneksamik asid infüzyonu tekrarlandı.Total cerrahi süre 100 dk, total kanama miktarı 150 ml idi. Hastanın kan tranfüzyonuna gereksinimi olmadı. Postoperatif 5.gün taburcu edildi. İntraoperatif kullanılan traneksamik asidin total kalça artroplastisinde kan kaybını ve kan transfüzyon gereksinimini azalttığı görüldü.

Keywords

traneksamik asid, total kalça protezi, Yehova Şahidi

References

• Stowers M, Lemanu DP, Coleman B et all. Review Article: Perioperative care in en- hanced recovery for total hip and knee ar- throplasty. Journal of Orthopaedic Surgery 2014;22(3):383-392
• Ralley FE, Berta D, Binns V et al. One intraoper- ative dose Tranexamic acid for patients having primary hip or knee arthroplasty. Clin Orthop Relat Res (2010) 468:1905-1911
• McConnell JS, Shewale S, Munro NA et all. Reduction of blood loss in primary hip arthro- plasty with tranexamic acid or fibrin spray. Acta Orthopaedica 2011; 82(6):660-663
• Lin ES, Kaye AD, Baluch AR. Preanesthetic as- sessment of the Jehovah’s witness patient. The Ochsner Journal 2012 ; 12:61-69.
• Carling MS, Jeppsson A, Eriksson B et al. Trans- fusionsand blood loss in total hip and knee ar- throplasty : a prospective observational study. Journal of Orthopaedic Surgery and Research 2015;10:48.
• Harwin SF, Issa K, Naziri Q et all. Results of primary total knee arthroplasty in Jehovah’s witness patient. The Journal of Arthrolasty 2013; 28: 49-55.
• Mangar D, Shube S, Kolla J et all. Inratavasku- lar balloon to minimize blood loss during total hip replacement in a Jehovah’s witness. Jour- nal of Clinical Anesthesia 2011; 23:71-74
• Duncan CM, Gillette BP, Jacob AK et all. Ve- nous thromboembolism and mortality associ- ated with Tranexamic acid use during total hip and knee arthroplasty. The Journal of Arthro- plasty 2015 ;30:272-276.
• Poeran J, Rasul R, Suzuki S et all. Tranexam- ic acid use and postoperative outcomes in patients undergoing total hip or knee ar- throplasty in the United States: retrospective analysis of effectiveness and safety. BMJ 2014;349:g4829