Effect of fibrinogen concentrates on blood loss in total knee arthroplasty

Total knee arthroplasty has been associated with marked blood loss that occurs despite the use of a tourniquet and minimal postoperative suction drainage. Autogenous fibrinogen cryoprecipitate was used to coat the operative site with a fibrin clot to determine the effect on postoperative blood loss. A method of determining the inapparent blood loss was used based on the red cell mass of the patient and using the hematocrit at the same point of time in relationship to the surgery for the control and study group. The magnitude of tissue extravasation was surprising, and it was almost double the blood loss expected by traditional methods. The benefit of using fibrinogen concentrates is exclusively confined to the inapparent blood loss and not the postoperative blood loss.