Clinical implications of using non-invasive haemoglobin monitoring for red blood cell transfusion decision in hip arthroplasty

Campos, Cristiana; Calheiros, José Manuel; Kreuzer, Matthias; Fernandes, Rita; Pinto, C; Seabra, Manuel; Vide, Sérgio

doi:10.1016/j.transci.2020.102770

Cited by 2 publications

(1 citation statement)

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“… 25 A recent study also showed that the use of the transfusion threshold determined using SpHb monitoring than using laboratory Hb had changed the clinical decision in only 1.9% of patients undergoing THA. 28 However, our results that SpHb can detect the anemia unnoticed by medical staff and reduce the total time and severity of accidental anemia at the postoperative rooms suggest that SpHb monitoring can reduce postoperative nadir Hb and prevent complications from unnoticed anemia after orthopedic surgery, which is an advantage, especially for elderly orthopedic patients. In another study, SpHb monitoring was useful in detecting delay in the detection of lower Hb levels, which is related to postoperative delirium in elderly patients with hip fractures.…”

Section: Discussionmentioning

confidence: 75%

Postoperative Noninvasive Hemoglobin Monitoring Is Useful to Prevent Unnoticed Postoperative Anemia and Inappropriate Blood Transfusion in Patients Undergoing Total Hip or Knee Arthroplasty: A Randomized Controlled Trial

Nakamori

Shigematsu

Higashi

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction Postoperative nadir hemoglobin (Hb) is related to a longer length of stay for geriatric patients undergoing orthopedic surgery. We investigated whether postoperative pulse Hb (SpHb) measurement is useful for avoiding anemia and inappropriate blood transfusion after total hip arthroplasty and total knee arthroplasty. Material and Methods This prospective randomized controlled study included 150 patients randomly assigned to receive blood transfusion, either guided by SpHb monitoring (SpHb group) or based on the surgeons’ experience (control group). The target laboratory Hb value was set to >8 g/dL at postoperative day 1 (POD1). The primary endpoints were the product of total time and degree of SpHb <8 g/dL (area under SpHb 8 g/dL) during the period up to POD1 and the incidence of laboratory Hb <8 g/dL at POD1. The secondary endpoints were the amount of blood transfusion and inappropriate blood transfusion, which was defined as allogeneic blood transfusion unnecessary in a case of SpHb >12 g/dL or delayed transfusion in a case of SpHb <8 g/dL. Results The area under SpHb 8 g/dL was 37.6 ± 44.1 g/dL-min (5 patients) in the control group and none in the SpHb group ( P = .0281). There was 1 patient with Hb <8 g/dL at POD1 in the control group. There was no difference in laboratory Hb levels and the amount of blood transfusion. Forty-one patients (19 in the control group and 22 in the SpHb group) received an allogeneic blood transfusion. Among these patients, 7 in the control group and none in the SpHb group received inappropriate blood transfusion ( P = .0022). Discussion The SpHb monitoring could reduce unnoticed anemia, which may prevent complications and be useful in avoiding unnecessary and excessive blood transfusion. Conclusion Postoperative SpHb monitoring decreased the incidence of transient, unnoticed anemia during the period up to POD1 and inappropriate blood transfusion.

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Section: Discussionmentioning

confidence: 75%