Blood loss in DMD patients is even higher in most series than amounts reported for cerebral palsy patients. Several large studies have reported mean blood loss amounts from 2,500 ml to 4,000 ml+ (Table 4). Other studies have reported lower mean values of 930–1,680 ml but even these reports show some patients at the 3,000, 4,000 ml levels. The blood loss amounts are further magnified in effect since many DMD patients are small in stature with low body weight. Fusion is invariably performed from the upper thoracic region to the sacrum encompassing 13–16 levels. Mean values of EBL per vertebral level are in the 200–280 ml range, although more recent studies with less blood loss are being reported.
|
Study [reference] (date of publication) / (date(s) of surgery) |
Estimated blood loss (EBL) (ml) [mean (range)] |
Number of procedures |
Technique |
Estimated blood loss / individual vertebral level in fusion (ml) (EBL/# levels=) |
Estimated blood loss / total blood volume |
Comments |
|---|---|---|---|---|---|---|
|
Marchesi et al. [45] (1997)/(1988–1993) |
930 (750–1500) |
25 |
Luque-Galveston with sacral screws, local bone graft plus allogeneic bone |
- |
- |
- |
|
Fox et al. [27] (1997)/(1989–1994) |
1028 (400–3000) |
19 |
Hartshill rectangle, allograft bone graft |
1028/12.5=82 |
30% |
Hypotensive anesthesia |
|
Mubarak et al. [50] (1993)/(1980–1987) |
1680 (250–4000) |
22 |
Luque system (10), Luque-Galveston (to pelvis, 12) autogenous iliac crest |
168/15.5=108 |
- |
- |
|
Ramirez et al. [58] (1997)/(1980–1993) |
2500 (1000–4500) |
30 |
Luque or Luque-Galveston (23), CDI 6, TSRH1; half autograft and half allograft |
- |
- |
- |
|
Bellen et al. [6] (1993)/(1984–) |
2633 (+/– 1100) |
47 |
Luque (12), Luque-Galveston (22), Hartshill (13), fusion to pelvis 38 of 47, local bone graft and allograft |
2633/136=194 |
84.5% |
- |
|
Noordeen et al. [54] (1999)/(1983–1993) |
2977 |
48 |
Harrington system and Harrington-Luque system |
2977/13=229 |
87% |
- |
|
Bentley et al. [8] (2001)/(1983–1996) |
3034 (500–8700) |
64 |
Luque, Harrington-Luque, or Luque-Galveston, local bone graft only |
3034/13=233 |
- |
- |
|
Weimann et al. [70] (1983)/(1974–1978) |
3067 (1830–4400) |
24 |
2 Harrington distraction rods; autogenous iliac crest bone grafts |
3067/12.8=240 |
- |
- |
|
Gibson et al. [29] (1978) |
3132 |
10 |
Harrington rod |
- |
- |
- |
|
Heller et al. [34] (2001)/(1992–1998) |
3373 (800–8500) |
31 |
ISOLA system |
3373/16=211 |
- |
- |
|
Shapiro et al. [61] (1992)/(1980–1990) |
3640 (+/– 1905) |
27 |
Luque or Harrington-Luque, iliac crest autograft (7), allograft (20) |
3640/13=280 |
- |
- |
|
Swank et al. [65] (1982)/(1967–1979) |
4064 (3300–6200) |
13 |
7/11 with 2 distraction Harrington rods |
4064/15=271 |
- |
- |
|
Sakai et al. [60] (1977)/(1972–1979) |
4400 |
6 |
- |
- |
- |
- |