全人工膝関節置換術後における回収式自己血輸血装置の使用によるＤ‐ダイマー値の上昇

概要

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Postoperative autologous transfusion of filtered shed blood (SBT) is a simple and inexpensive method to avoid allogeneic blood transfusion, and has been widely used in total knee arthroplasty (TKA). In the present report, we used a postoperative wound drainage and return system with filter in one patient who underwent bilateral serial TKA. Postoperative complications, plasma D-dimer (DD) and hemoglobin values were evaluated. A 72 year old woman who was suffering from rheumatoid arthritis received first left side TKA operation, blood transfusion was not required during the procedure. Five months later, she received a right TKA and postoperative SBT. No evident clinical complications were observed after both procedures. Hemoglobin values showed minimal differences in both postoperative courses when evaluated one week after the surgery. Interestingly, the DD values measured during postoperative day 1, were higher following the 2nd TKA comparing to the 1st TKA, 56.6μg/ml and 4.2μg/ml, respectively. The DD value reflects the degree of second fibrinolytic activity, and we speculated there may be a lot of micro-coagulation clots in the filtered shed blood. For that reason DD values have to be carefully interpreted particularly during the immediate post operative period, because coagulation-fibrinolytic activity may be greatly influenced by SBT.
中国・四国整形外科学会の論文