Abstract
Several authors have identified on admission haemoglobin level as the most useful
predictor of transfusion risk in patients with a hip fracture. A low postoperative
haemoglobin unexplained by perioperative blood loss is not uncommon in these patients.
The drop in haemoglobin after re-hydration prior to surgery should depend not only
on the degree of dehydration but also on the amount of blood lost in the fracture.
We could find no study in the English literature estimating the magnitude of this
fall in haemoglobin after re-hydration prior to surgery.
We conducted a prospective study to estimate the magnitude of fall in haemoglobin
after re-hydration prior to surgery by repeating the full blood count after at least
12 h of preoperative fluid resuscitation in 127 patients with hip fracture (75 consecutive
at one centre and 52 consecutive at another).
The average preoperative drop in haemoglobin was 2.23 gram/decilitre (g/dL) (p-value = 0.00) in subtrochanteric fractures, 1.1 g/dL (p-value = 0.001) in intertrochanteric fractures and 0.7 g/dL (p-value = 0.02) in intracapsular fractures. Fifteen patients with a haemoglobin level >9 g/dL on admission were found to have a haemoglobin level <9 g/dL on repeat test and were prevented from going to theatre without arrangements
for perioperative transfusion during this study. Their predicted average postoperative
haemoglobin without perioperative blood transfusion was calculated to be 6.5 g/dL.
The on admission haemoglobin level was found to be falsely reassuring and could lead
to a very low postoperative haemoglobin level. This could prove to be dangerous for
many patients especially if remains undetected for several hours. We recommend that
all patients with subtrochanteric fractures, and all patients with intertrochanteric
or intracapsular fractures with a haemoglobin of less than 12 g/dL on admission have a repeat haemoglobin level performed prior to their surgery.
Keywords
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Article info
Publication history
Accepted:
July 12,
2010
Footnotes
☆Study conducted at Morriston Hospital, Swansea and Wrexham Maelor Hospital, Wrexham, UK.
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
