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Validation of a haemoglobin dilution method for estimation of blood loss
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
2008 (English)In: Vox Sanguinis, ISSN 0042-9007, E-ISSN 1423-0410, Vol. 95, no 2, 120-124 p.Article in journal (Refereed) Published
Abstract [en]

Background and Objectives: Analysis of haemoglobin (Hb) dilution after bleeding is a simple, inexpensive and non-invasive method to estimate blood loss. Blood volume is estimated, taking sex, weight and height into account. The Hb concentration before and after blood loss is analysed and, from the difference, the blood loss volume can be calculated assuming a normovolemic subject. Although widely used this method has never been validated.

Material and Methods: The Hb concentration of 21 blood donors was analysed before and up to 4 days after a standard blood donation and in another 18 blood donors the Hb concentration was analysed before and on day 4, 6, 8, 11 and 14 after blood donation. The blood volume of each donor was calculated and the donated blood volume was estimated by weighing. We calculated the blood loss by the Hb dilution method and compared the calculated value with the donated blood volume.

Results: The mean donated blood volume was 442 ± 10 ml, whereas the mean calculated blood loss was 152 ± 214 ml using the Hb concentration of the first day after donation and 301 ± 145 ml with the Hb concentration of day 6 after blood donation after which no further Hb decrease was observed. The directly measured Hb concentration was always higher than the calculated/expected Hb concentration based on the blood donation volume.

Conclusions: The Hb dilution method underestimates the true blood loss by more than 30% after a moderate blood loss of approximately 10% of the total blood volume.

Place, publisher, year, edition, pages
Wiley InterScience , 2008. Vol. 95, no 2, 120-124 p.
Keyword [en]
Blood loss estimation, Hb decrement, Hb dilution
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-15113DOI: 10.1111/j.1423-0410.2008.01071.xOAI: oai:DiVA.org:liu-15113DiVA: diva2:54422
Available from: 2008-10-16 Created: 2008-10-16 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Cyclooxygenase-2 inhibitors and knee prosthesis surgery
Open this publication in new window or tab >>Cyclooxygenase-2 inhibitors and knee prosthesis surgery
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Adverse effects of cyclooxygenase (COX) inhibitors on bone healing have previously been demonstrated in diaphyseal fracture models in animals. In spite of that, they are widely used as postoperative analgesics in orthopaedic surgery. After joint replacement, a bone repair process starts at the interface between bone and cement. If this process is disturbed, the prosthesis may never become rigidly fixed to the bone, leading to migration and with time loosening.

This thesis investigates the effects of a selective COX-2 inhibitor (parecoxib or celecoxib) on bone healing in metaphyseal bone in a rat model and on knee prosthesis migration after total knee replacement, as measured with radiostereometric analysis. Blood loss, postoperative recovery, and the 2-year subjective outcome, were also measured. In addition, a hemoglobin dilution method for blood loss estimation, used in this thesis, was evaluated.

In the first study, pull-out force of a screw inserted in metaphyseal bone of the tibia in rats was only marginally decreased by parecoxib after 7 days but not after 14 days. In the second and third study, celecoxib treatment resulted in less pain postoperatively in conjunction with total knee replacement (TKR), but no effects were seen on blood loss, range of motion, subjective outcome, or prosthesis migration after 2 years.

Comparing the true blood loss of blood donors with the blood loss estimated by the hemoglobin dilution method, this method was found to underestimate the true blood loss. It is therefore not suitable for calculation of the absolute blood loss volume, but may be used for a rough estimate.

In summary, celecoxib and presumably other cyclooxygenase inhibitors seems not likely to increase the risk of prosthesis loosening.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2008. 48 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1077
Keyword
Non-steroidal anti-inflammatory agents, administration & dosage, Arthroplasty, knee replacement, Surgical blood loss, Surgery, Cyclooxygenase inhibitors, Cyclooxygenase inhibitors, Fracture healing, Isoxazoles, Postoperative pain, Pyrazoles, Sulfonamides
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-15114 (URN)978-91-7393-811-2 (ISBN)
Public defence
2008-09-19, Eken, Hälsouniversitet, ingång 65, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2008-10-16 Created: 2008-10-16 Last updated: 2009-08-21Bibliographically approved

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Meunier, AndreasGood, LarsBerlin, Gösta

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Orthopaedics and Sports Medicine Faculty of Health SciencesDepartment of Orthopaedics LinköpingDepartment of Clinical and Experimental MedicineDepartment of Clinical Immunology and Transfusion Medicine
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Vox Sanguinis
Surgery

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