Haemoglobin drift in patients following Whipple's procedure

Abstract

AbstractBackgroundsThis study aims to identify the objective findings of haemoglobin (Hb) drift in patients that had a Whipple's procedure in the last 10 years, their transfusion status intraoperatively and post‐operatively, the potential factors affecting Hb drift, and the outcomes following Hb drift.MethodsA retrospective study was conducted at Northern Health, Melbourne. All adult patients who were admitted for a Whipple's procedure from 2010 to 2020 were included and information collected retrospectively for demographics, pre‐operative, operative and post‐operative details.ResultsA total of 103 patients were identified. The median Hb drift calculated from a Hb level at the end of operation was 27.0 g/L (IQR 18.0–34.0), and 21.4% of patients received a packed red blood cell (PRBC) transfusion during the post‐operative period. Patients received a large amount of intraoperative fluid with a median of 4500 mL (IQR 3400‐5600). Hb drift was statistically associated with intraoperative and post‐operative fluid infusion leading to concurrent issues with electrolyte imbalance and diuresis.ConclusionHb drift is a phenomenon that does happen in major operations such as a Whipple's procedure, likely secondary to fluid over‐resuscitation. Considering the risk of fluid overload and blood transfusion, Hb drift in the setting of fluid over‐resuscitation needs to be kept in mind prior to blood transfusion to avoid unnecessary complications and wasting of other precious resources.