Analysis of hidden blood loss and its influential factors in myomectomy

Abstract

Objective This study was performed to quantify hidden blood loss (HBL) and explore its influential factors in myomectomy. Methods Two hundred nine patients who underwent myomectomy by laparotomy or laparoscopy from 1 January 2017 to 31 December 2018 were analyzed. Each patient’s estimated blood volume and total blood loss (TBL) were calculated by the Nadler formula and Gross formula, respectively. The HBL was calculated by subtracting the visible blood loss (VBL) from the TBL. A multivariate linear stepwise analysis was applied to identify the influential factors of HBL in myomectomy. Results The mean perioperative VBL and estimated TBL during myomectomy were 137.81 ±104.43 and 492.24 ± 225.00 mL, respectively. The mean HBL was 354.39 ± 177.69 mL, which accounted for 71.52% ± 15.75% of the TBL and was two to three times higher than the VBL. The duration of surgery, number of removed leiomyomas, and location of removed leiomyomas were independent risk factors for HBL in myomectomy. Conclusions HBL accounted for a significant percentage of TBL in myomectomy. A full understanding of the HBL in perioperative blood management may improve patients’ postoperative rehabilitation.

Hidden blood loss and its risk factors in patients undergoing conventional laparoscopic surgery and laparoendoscopic single‐site surgery for ovarian cystectomy

“…Moreover, when the operation time is longer, the blood may coagulate in the third space and cannot be drained out, which is usually ignored in the evaluation of VBL. 17 Therefore, we believe that reasonable control of surgery time can reduce HBL and has a positive effect on the recovery of patients.…”

“…We hypothesized that with the extension of surgical time, the maintenance time and the dosage of muscle relaxants would be added during anesthesia, which contributes to blood infiltration into the tissue space and becoming part of HBL. Moreover, when the operation time is longer, the blood may coagulate in the third space and cannot be drained out, which is usually ignored in the evaluation of VBL 17 . Therefore, we believe that reasonable control of surgery time can reduce HBL and has a positive effect on the recovery of patients.…”

Can the application of a temporary uterine tourniquet during an abdominal myomectomy reduce bleeding?

“…Perioperative bleeding is the most common complication in a myomectomy ( 6 ). Previous research reported that the surgery duration and uterine leiomyoma number were risk factors for increased blood loss, with a longer surgery duration and removal of multiple uterine leiomyomas associated with increased blood loss ( 11 ). This research also reported that increased myomectomy-related blood loss contributed to delayed post-operative recovery by increasing the need for blood transfusions and the risk of fevers, infections and abdominal adhesions ( 12 ).…”

Effects and Safety of Traditional Chinese Medicine for Hidden Blood Loss after Total Hip Arthroplasty—A Systematic Review and Meta-Analysis

“…HBL refers to the e ective circulation of hemoglobin and red blood cells entering the interstitial space after the operation, resulting in swelling of the a ected limb which is not directly lost to the outside world. e hazards of hidden blood loss include postoperative anemia and complications such as slow wound healing, poor functional recovery, and increased risk of infection caused by anemia [29,30]; increased risk of deep vein thrombosis in the lower extremities; increased probability of cardiovascular and cerebrovascular accidents; and subcutaneous ecchymosis [31]. Hidden blood loss falls into the category of "blood syndrome" in clinical Chinese medicine and can be traced back to " e Yellow Emperor's Classic of Internal Medicine."…”