Efficacy and safety of fibrin glue and tranexamic acid to prevent postoperative blood loss in total knee arthroplasty: a randomized controlled clinical trial.

BACKGROUND: Postoperative blood loss in patients after total knee arthroplasty may cause local and systemic complications and influence clinical outcome. The aim of this study was to assess whether fibrin glue or tranexamic acid reduced blood loss compared with routine hemostasis in patients undergoing total knee arthroplasty. METHODS: A randomized, single-center, parallel, open clinical trial was performed in adult patients undergoing primary total knee arthroplasty. Patients were divided into four groups. Group 1 received fibrin glue manufactured by the Blood and Tissue Bank of Catalonia, Group 2 received Tissucol (fibrinogen and thrombin), Group 3 received intravenous tranexamic acid, and Group 4 (control) had no treatment other than routine hemostasis. The primary outcome was total blood loss collected in drains after surgery. Secondary outcomes were the calculated hidden blood loss, transfusion rate, preoperative and postoperative hemoglobin, number of blood units transfused, adverse events, and mortality. RESULTS: One hundred and seventy-two patients were included. The mean total blood loss (and standard deviation) collected in drains was 553.9 ± 321.5 mL for Group 1, 567.8 ± 299.3 mL for Group 2, 244.1 ± 223.4 mL for Group 3, and 563.5 ± 269.7 mL for Group 4. In comparison with the control group, Group 3 had significantly lower total blood loss (p < 0.001), but it was not significantly lower in Groups 1 and 2. The overall rate of patients who had a blood transfusion was 21.1% (thirty-five of 166 patients analyzed per protocol). Two patients required transfusion in Group 3 compared with twelve patients in Group 4 (p = 0.015). No significant difference was observed between the two fibrin glue groups and the control group with regard to the need for transfusion. There was no difference between groups with regard to the percentage of adverse events. CONCLUSIONS: Neither type of fibrin glue was more effective than routine hemostasis in reducing postoperative bleeding and transfusion requirements, and we no longer use them. However, this trial supports findings from previous studies showing that intravenous tranexamic acid can decrease postoperative blood loss.

Late seroconversion of C virus markers in hemodialysis patients.

We examined the prevalence of the IgG C virus C 100-3 antibody (anti-HCV) in a group of 43 patients on hemodialysis in our center during three periods: A: 1988; B: 1989; C: 1990. During period A, the anti-HCV prevalence was 30% (13 of 43 patients), these patients being regarded as chronic carriers of these antibodies. In period B, two patients displayed seroconversion, and another seven during period C, all of whom had tested negative during period A. These patients were considered acute. During the three years under study, all of the patients shared the same hemodialysis monitors. High ALT values were found in four of nine acute patients (44.4%) and nine of thirteen (69.23%) of the chronic patients. In 10 anti-HCV patients, hypertransaminemia continued long-term (> 6 months). Two patients had been given contaminated blood, four were multi-transfused (> 14 transfusions), two less than 4 units, and one had never received a transfusion. The period between the initial high and/or maximum ALT and the determination of HCV Ac was up to 10 to 11 months in three patients. These findings indicate the lack of sensitivity of ALTs as a diagnostic tool for HCV, the possible late C 100-3 seroconversion, which makes it necessary to carry out periodic serological checks in hemodialysis patients and the decisive role transfusions in HCV transmission, without excluding other possible intra-dialysis contagion sources.

[Automatic reading of ABO and Rh groups on microplates using FMC medium and an IBG Systems reader]. / Lectura automática del grupo ABO y Rh en microplaca empleando el medio FMC y el lector de IBG systems.

We present in this paper our experience in the routine use of an automatic reader for microtiter plates (IBG Systems). A total of 2044 samples from blood donors have been tested for ABO (haematic and seric) and Rh (D antigen) blood group typing. The red blood cell samples have been tested against monoclonal anti-A, anti-B, anti-AB and anti-Rh 1 (D) sera (using two different anti-D reagents). As a negative control, 3% albumin solution was employed. In order to determine the seric groups, the plasma samples were tested against A1, A2, B and 0 cells. In all cases the red cells were suspended in Ficoll 400R-Methyl cellulose (FMC), and 0.01 Bromelin was added to red blood cell samples to be typed. The obstacles in the automatic readings were mainly solved by visual reading of the microplates. In the 2,044 samples analysed with the automatic reader, 19 discrepancies (0.94%) were found in ABO typing. In all cases the error was in the seric blood group. Three false positive reactions were found with 0 red cells. Two false negative with B red cells, interpreted by the automatic reader as doubtful results. Three positive readings were detected, in one case the positivity was due to alloantibodies (C + D specificities), the other two cases were autoagglutinations. False negative reactions were found, in 11 cases, 8 of them due to lipaemia and the remaining three were haemolysed plasma samples. It should be stressed that out of 19 cases of discrepancy, only 5 (0.24%) were due to the automatic reader while the remaining were due, to sample troubles.(ABSTRACT TRUNCATED AT 250 WORDS)