Prediction of Intraoperative Blood Loss during Total Knee Arthroplasty in HCV+ and HCV- Patients with Hemophilia A

Abstract

We examined HCV+ and HCV- hemophilia A patients with knee arthropathy and hematocrit above 38.5%. The mean density of erythrocytes was studied by the phthalate method, intraoperative blood loss was assessed gravimetrically. The volume of blood loss in HCV+ patients with manifest adhesive process and chronic synovitis varied from 300 to 1900 ml, in patients with moderate adhesive process from 400 to 1500 ml. The volume of blood loss in HCV- patients was 300-800 ml. A positive correlation between the blood loss volume and mean density of erythrocytes was detected. Blood loss >1000 ml during total knee arthroplasty can be expected in patients with hemophilia A with HCV and high mean density of erythrocytes. Blood loss >1000 ml is unlikely in HCV- and HCV+ patients with the mean density of erythrocytes not surpassing the normal values.

Risk factors for increased perioperative blood loss during total knee arthroplasty in patients with haemophilia

“…There have been few studies on risk factors for PBL in patients with haemophilia. Although preoperative haematocrit of <38.5%, increased erythrocyte density and HCV infection were reported as risk factors, 2,4 the methods used to assess blood loss in these studies were not accurate because they failed to measure hidden blood loss. Additionally, independent risk factors were not analysed.…”

“…Shurkhina et al reported that intraoperative blood loss during TKA increases in patients with haemophilic arthropathy when haematocrit levels are lower than 38.5%, 2 hepatitis C virus (HCV) is positive and erythrocyte density is high. 4 Although increased blood loss is an important factor that has the potential to affect the clinical outcome after TKA, 5,6 there have been no additional studies analysing the risk factors for increased blood loss after TKA for haemophilic arthropathy of the knee. Furthermore, these aforementioned studies calculated blood loss during surgery using the weight of pre-and postoperative cloths and the volume of blood in a suction pump, which failed to assess for any hidden blood loss.…”