Eliminate Complete Blood Count in Primary THA?

Researchers from Duke University Medical Center in Durham, North Carolina, have determined that complete blood count (CBC) tests are not always necessary after total hip arthroplasty (THA).

Their work, “When Should Complete Blood Count Tests Be Performed in Primary Total Hip Arthroplasty Patients?” appears in the May 28, 2018 edition of The Journal of Arthroplasty.

The authors wrote, “This retrospective review identified 352 patients who underwent primary THA at a single institution from 2012 to 2014. Preoperative and postoperative CBC values were collected along with demographic data, use of tranexamic acid (TXA), and transfusion rates.”

Beau J. Kildow, M.D., an orthopedic resident at Duke University Medical Center and co-author on the study told OTW, “Driving down cost while improving patient care is of significant importance today especially with increased emphasis on physician outcomes. We wanted to break down all the cost per episode of care for primary TJA [total joint arthroplasty] and identify categories to potentially cut cost without sacrificing patient care.”

The authors wrote, “Of the 352 patients, 54 patients were transfused (15.3%). Patients who underwent transfusion had a significantly lower preoperative hemoglobin compared to patients who did not undergo transfusion. Patients who did not receive TXA were 3.7 times more likely to receive a transfusion. No patients received medical intervention based on the outcome of postoperative platelet or white blood counts.”

Dr. Kildow told OTW, “With the movement to outpatient total joint arthroplasty, it appeared that healthy patients undergoing primary joint arthroplasty did not experience any complications or medical interventions based off post-operative labs that are routinely obtained.”

“A routine CBC following a primary THA can safely be omitted in patients without preoperative anemia and who receive TXA.”

“Female patients without preoperative anemia or who receive TXA are at negligible risk for transfusion despite being an identified risk factor. Although no patients in our study received medical management for abnormal WBC [white blood cells] or platelet values, patients with known diseases affecting these cell lines should be managed accordingly.”

“Ordering a postoperative CBC is not necessary for healthy patients without preoperative anemia and who receive TXA.”

“Depending on the type of practice, many patients undergoing primary TJA are healthy individuals. Refraining from ordering CBC tests on these patients is safe and cost effective. Furthermore, patients may happier knowing they will not receive another blood draw especially if they are routinely obtained early in the morning.”