Post-Surgery Anemia and Fever Following Total Hip Replacement
Is there a doctor in the house? A patient weighing 165 lbs (down from 175 the previous week) presents with a history of atrial fibrillation, a loop recorder in place, and high blood pressure, alongside arthritis. The surgery for a right total hip replacement took place on June 2, 2025. From June 4 to June 24, the patient underwent subacute rehabilitation while battling anemia, with hemoglobin levels peaking at 8.7, significantly lower than the pre-operative level of 13.1. To address this, two iron infusions were administered, yet the patient returned home with the same low hemoglobin reading of 8.7. On June 28, the individual experienced fatigue along with a fever, leading to an emergency room visit where the hemoglobin measured at 7.2. Consequently, two blood transfusions were provided, after which the patient was discharged on July 4, with hemoglobin at 7.9. However, just a few hours at home resulted in another fever, prompting a return to the emergency room where a urinary tract infection and sepsis were diagnosed. The patient was discharged on July 7, noted to have no fever during their hospital stay. An episode of atrial fibrillation lasted 25 minutes on July 4. After another brief return home, another fever ensued. A new hospital admission occurred on July 7, revealing a further decline in hemoglobin to 6.8, which led to yet another transfusion. While the bone marrow response was noted as slow but improving, a CT scan of the right hip indicated the presence of fluid. The medical team opted against aspiration, suspecting the fluid to be a hematoma. Following another blood transfusion, hemoglobin increased to 8.9, and again, no fever was recorded during the hospital stay. The patient was discharged on July 12. Shortly after returning home, following a shower and nap, the patient developed a fever of 102°F. On July 12, another ER visit revealed a rectal temperature of 102°F (oral temperature did not match), leukocytosis at 14.5, and hemoglobin remaining stable at 9. No additional fevers have occurred since. Lab results show low levels of albumin and rising red blood cells. Today, a bone marrow and white blood cell scan were conducted, resulting in the following impressions: 1. Soft tissue infection near the right hip arthroplasty, with no signs of periprosthetic bone infection. 2. Presence of pseudomembranous colitis in the ascending colon. While the findings suggest inflammation rather than infection, the team plans to aspirate the right hip tomorrow. What could be overlooked? What questions should I raise? The medical staff seems perplexed, and I find it frustrating to undergo these procedures if they are neither beneficial nor required.
Answers (1)
7/17/2025, 1:10:55 AM
OpenHealth AI
It sounds like you're going through a very challenging time following your hip replacement surgery, particularly with recurrent fevers, anemia, and ongoing complications. I appreciate how overwhelming this can feel, especially when the medical team is trying to uncover the root cause of your symptoms. Let’s break this down to address your concerns and potential questions.
Main Points:
- Persistent Anemia and Infection Risks: Your hemoglobin levels have fluctuated and remain low, while you also experience recurring fevers and potential soft tissue infection.
- Assessment of Symptoms: There could be interactions between your anemia, infections, and post-surgical recovery that need deeper investigation.
- Questions to Discuss with Your Medical Team: Clear communication is essential to ensure all concerns are addressed.
Explanation:
After a major surgery like total hip replacement, it is common to experience complications such as anemia and infections. The low hemoglobin levels indicate a significant loss of red blood cells, which may be due to bleeding, infection, or insufficient production post-surgery. Your recurrent fevers suggest there could be an ongoing inflammatory process or infection.
The findings of soft tissue infection and pseudomembranous colitis could be connected to your symptoms. If the antibiotics were not effective, it's essential to consider ways to optimize treatment.
Next Steps:
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Monitor Symptoms Closely: Keep track of your fever patterns, any changes in your physical condition, and your energy levels. Documenting this information will be helpful for your healthcare team.
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Ask Targeted Questions:
- What are the specific reasons for the soft tissue infection diagnosis, and what treatments are being considered?
- Could the pseudomembranous colitis be contributing to your symptoms and anemia?
- How will the medical team manage your anemia moving forward?
- What preventive measures are being taken to manage the risk of further infections or complications?
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Discuss Blood Management Strategies: Inquire about potential options for addressing anemia, such as different iron preparations, erythropoiesis-stimulating agents, or dietary changes. Understanding the expected outcomes of any proposed treatments is crucial.
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Plan for Infection Management: Discuss the rationale for reducing any ongoing inflammatory or infectious processes. Ask about culture results or sensitivity testing for the infection.
It's understandable to feel frustration when treatments seem ineffective; advocating for your health is crucial. Express your concerns about the procedures and seek clarification on their necessity and expected benefits.
If you continue to experience difficulties or feel your questions aren’t being adequately addressed, consider requesting a more detailed sit-down talk with the medical team or seeking a second opinion from another specialist who can re-evaluate your care plan. You deserve to feel heard and understood.
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