A few weeks prior to my joint replacement surgery, I was required to have pre-admission testing completed. There was a laundry list of things to get done, blood tests, chest x-ray, EKG, a review of systems essentially, to make sure my body was up for the fun and games to come. What had I gotten myself into?!?!?!
Our local medical center did a fabulous job with this potentially very nerve-wracking experience. They wrapped all of this testing in with an educational session. Knee Replacement 101! Breakfast was served (after the fasting blood work was drawn, of course!) and all of your questions (and the questions you didn’t know you had) were answered. I left feeling calm, ready, my super-duper antibacterial soap and antibiotic ointment in hand (for my pre-surgery shower and nasal swabbing- let’s prevent those hospital acquired infections! 🙂 ). I had this! (I think…)
All that blood work!!! What does it mean? We’d be here for days if we went through each and every test and value- but here’s a really important pair you should definitely be familiar with, if you are not already. Hemoglobin and Hematocrit. Should your hematocrit (the volume of red blood cells in your body) come back low, your team will advise you if you need extra supplementation (vitamins, diet adjustments) prior to the surgery. Iron rich foods will likely be suggested, things like lean red meats, seafood, fish, poultry and eggs, legumes, dark leafy greens (spinach, kale, etc.), dried fruits, nuts, seeds (pumpkin, chia, sunflower). Having an optimal hemoglobin (the protein that carries the oxygen in your blood) and hematocrit is favorable for your surgery day.
Joint replacement surgery is a lot like carpentry. There’s measuring, cutting, sawing, fitting and cementing. Being that this is all taking place within the body, blood loss can quickly become an issue, not just intra-operatively, but post-operatively as well.
The estimated average blood loss during knee replacement surgery is 1000mL (plus or minus 400mL). The average adult human has about 5L of blood, total volume. Loosing 1.4L of blood is 28% of that total blood volume. Imagine the strain that can put on the body, which is already stressed from the surgery itself. Getting oxygen and nutrients to tissues damaged intra-operatively is essential to begin healing. Replacing that lost blood is vital. Watching that H&H (hemoglobin and hematocrit) as well as monitoring your visible bleeding will be how your team measures your blood loss.
Blood transfusions are not uncommon for an individual undergoing joint replacement. Keeping blood levels optimal are the goal of the medical team, before, during and after your procedure. This will help you tolerate the procedure better, heal better and get moving quicker. Keeping your blood levels in the best range possible for you will happen by a variety of different ways. IV solutions are one way. They hydrate, increasing plasma volume. Blood products (packed red blood cells, whole blood) can be transfused either from blood you have previously donated, a donor other than you, or from blood collected during your surgery or from your draining wounds, and re-transfused back to you.
Having had both of my knees replaced, at the same time, in the same surgery, I experienced a pretty significant blood loss. My team tackled this by keeping me optimally hydrated, supplemented with iron, and auto-transfusing me. I received my own blood, cleaned and recycled (for lack of a better analogy) right back into my body. Both in the operating room and in my hospital room, I was connected to an autotransfusion machine. You can see the tubing in the picture above, snaking out of my dressings, down the bed- they go out to the machine, then back into the IV in my arm that is up and waving to the camera (and probably started beeping a second after this picture was taken, lol! This was snapped just a few hours after my procedure was completed). This machine collected my lost blood, treated and clean it, and transfused it back into my body. The technology of these machines runs similar to the heart and lung bypass machines and hemodialysis machines. Cleaning the blood of any impurities or toxins, gently preserving the red blood cells and returning the blood product to the body. The benefits of using an autotransfusion machine over blood bank blood are disease transmission, adverse effects (allergic or otherwise), and no shortage of type compatibility, to name a few. As with any medical procedure, there are risks involved (air emboli, infection, potential for clotting), but in my case the benefits far outweighed the risks.
I came across these sobering statistics while reading up on this topic….
“It is estimated that in general 15 million transfusions are performed each year, with 20% having some adverse effect. Risk of HIV transmission is a major concern, with 1–2% of transfusions developing this [28]. Allogenic transfusion is also associated with many immunological and other non-infectious transfusion complications [11]. The reported mortality rate for mismatched transfusions is variable, but can be expected to be approximately 10% due to shock, renal failure and bleeding [19]. Even autologous transfusion is not risk free, autologous donors as a group tend to be older and less healthy, which increases the chance of complications during donation, and of unrecognised bacteraemia at the time of blood collection [18, 29]. Autologous transfusion may actually lead to decreased haemoglobin levels post-operatively, resulting in transfusion of autologous blood in people who, if they had not donated and thus lowered their haemoglobin level before surgery, would not have needed transfusion [7]. Autologous transfusion also causes unnecessary wastage of blood and unnecessary expenses [4, 7, 16].”
Int Orthop. 2007 Feb; 31(1): 39–44.Blood loss in total knee arthroplasty: an analysis of risk factors
Narayana Prasad,corresponding author Vinod Padmanabhan, and Arun Mullaji
So the take away here?
Every facet of this procedure has decisions to be made. Many will not be ours as the patient to make, but being informed about the process, knowing what questions to ask, and being genuinely interested in the what, why and how WILL get you a better outcome. Understand what is happening to you. Read. Talk. Ask, and ask again, until you understand!
Be Well!
-Laurie
