Bleeding Control

Bleeding is an unavoidable complication of total hip arthroplasty (THA); however, excessive bleeding is a severe perioperative complication. THA involves the manipulation of bones, such as reaming the acetabulum or femur, which may result in excessive blood loss. Conventional methods for blood loss control include managing hypotensive anesthesia and autologous or allogeneic blood transfusions to compensate for blood loss based on the expected blood loss. However, allogeneic blood transfusion should be avoided as much as possible because of concerns of serious complications, such as transfusion-related infections, including infections of hepatitis viruses and human immunodeficiency virus (HIV), graft-versus-host disease, production of abnormal irregular antibodies due to allogeneic immunity, and transfusion-related circulatory overload. Current hemorrhage control measures recommend patient blood management (PBM), which focuses on the resolution of anemia, prevention of blood loss, and appropriate blood transfusion. Autologous blood transfusions or hemostatic measures should be considered to minimize allogeneic blood transfusion as well as ensure smooth and safe surgical and perioperative management [1]. PBM should be planned for preoperative, intraoperative, and postoperative periods. It should include increasing preoperative hemoglobin levels and optimizing hemostatic coagulation, improving surgical techniques and hemostatic procedures, reducing intraoperative and postoperative blood loss through improved anesthetic management, and using limited and restrictive blood products based on the indication [2].