Bleeding risk screening for transfusion in thrombocytopenic patients undergoing joint replacement: a retrospective case-series

Herng-Shouh Hsu ； Feng-Chih Kuo ； Po-Chun Lin ； Mel-S. Lee ； Cheng-Ta Wu

《Formosan Journal of Musculoskeletal Disorders》 13卷1期 (2022/02) Pp. 25-32

https://doi.org/10.6492/FJMD.202202_13(1).0003

摘要

Introduction: Joint replacements with optimized outcomes rely on practiced techniques and comprehensive management of patients' underlying condition. In patients with thrombocytopenia, a reduced platelet level can be associated with increased transfusion rates and perioperative complications. Purposes: Our study evaluated the practicality and safety of a designed bleeding tendency screening questionnaire with reference to platelet count in determining prophylactic platelet transfusion for thrombocytopenic patients undergoing arthroplasty. Methods: Thrombocytopenic patients undergoing 16 arthroplasties were retrospectively reviewed. The questionnaire included three clinical signs of bleeding tendency: (1) Do you frequently encounter gum bleeding while brushing your teeth? (2) Do you easily develop bruises from low-intensity injuries? (3) Have you had events of gastrointestinal bleeding in the recent six months? Results were assessed in correlation to prophylactic and therapeutic transfusion rates, surgical parameters, and outcomes. Results: Three patients had severe (＜ 50 × 10^9/L), 11 moderate (50-99 × 10^9/L), and 2 mild (100-149 × 10^9/L) thrombocytopenia. Patients with mild and moderate thrombocytopenia screened negative for bleeding risk received no platelet transfusions. Higher mean platelet counts (95.3 × 10^9/L) and lower mean estimated blood loss (666 mL) were observed in the screened negative group compared to lower mean platelet counts (66.2 × 10^9/L) and higher mean estimated blood loss (1,123 mL) in the group screened positive. Patient answering yes to easy bruising had higher risk for prophylactic and therapeutic platelet transfusions with odds ratio of 3.3 (95% confidence interval [CI]: 1.7-7.3) and 2.6 (95% CI: 1.0-6.8) respectively. Conclusions: There are no established guidelines for platelet transfusion in thrombocytopenic patients undergoing arthroplasty. Our designed questionnaire provided safe results, yielding reduced platelet transfusion rate, low complication rate, and satisfactory surgical outcomes.

關鍵字

arthroplasty ； blood transfusion ； platelet count ； thrombocytopenia