Nacca Christopher R, Shah Kalpit N, Truntzer Jeremy N, Rubin Lee E
Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Orthopaedic Surgery, Brown University, Providence, RI, USA; Department of Orthopaedic Surgery, Rhode Island Hospital, Providence, RI, USA.
Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Orthopaedic Surgery, Rhode Island Hospital, Providence, RI, USA; Department of Orthopaedic Surgery, The Miriam Hospital, Providence, RI, USA; Division of Adult Reconstruction, Department of Orthopaedic Surgery, Providence, RI, USA.
Arthroplast Today. 2015 Nov 6;2(4):177-182. doi: 10.1016/j.artd.2015.10.004. eCollection 2016 Dec.
Patients with afibrinogenemia or hypofibrinogenemia present a unique challenge to the arthroplasty surgeon as fibrinogen is a key contributor to hemostasis. Patients with these disorders are known to have a higher risk for postsurgical bleeding complications. We present the case of a patient with hypofibrinogenemia who underwent an elective total knee arthroplasty. Our colleagues in hematology-oncology guided us initially to achieve and maintain appropriate fibrinogen levels in the early perioperative period. However, the patient developed an acute joint effusion and subsequent infection 4 weeks after her initial operation. Her fibrinogen levels were noted to have fallen below the target range by that time, and it was also revealed that the patient failed to follow-up with hematology-oncology to monitor her levels. Based on our review of the available literature, we recommend that patient's fibrinogen levels be closely monitored and maintained ideally >100 mg/dL not only in the initial perioperative window but perhaps for the first 4-6 weeks postoperatively as well.
纤维蛋白原缺乏血症或低纤维蛋白原血症患者给关节置换外科医生带来了独特的挑战，因为纤维蛋白原是止血的关键因素。已知患有这些疾病的患者术后出血并发症风险更高。我们报告了一例接受择期全膝关节置换术的低纤维蛋白原血症患者的病例。血液肿瘤学领域的同事最初指导我们在围手术期早期达到并维持适当的纤维蛋白原水平。然而，该患者在初次手术后4周出现急性关节积液及随后的感染。当时发现她的纤维蛋白原水平已降至目标范围以下，还发现该患者未听从血液肿瘤学医生的建议进行随访以监测其纤维蛋白原水平。基于我们对现有文献的回顾，我们建议不仅在围手术期初期，而且可能在术后的前4至6周内，都应密切监测并理想地维持患者的纤维蛋白原水平>100mg/dL。
