Using of Intraoperative Cell Salvage and Tranexamic Acid as Protective Factor for Postoperative Anemia Appearance in Patients with Total Hip or Knee Arthroplasty
Round 1
Reviewer 1 Report
The authors have presented a good assessment of the intraoperative pharmacological and nonpharmacological methods and techniques for reducing blood loss in patients with postoperative anemia after Total Joint Arthroplasty.
- However, can the authors clarify why factors like the duration of surgery and type of surgery (i.e. unilateral vs bilateral) not taken into account for this study. Not only these would be factors affecting PA but it would at least contribute to factors like total RBC volume loss and RBC salvaged volume in Table 2.
- And also would these factors possibly dictate the dose requirements for the pharmacological methods?
Apart from this, some minor comments:
- Lines 99-100 mention the use of Tourniquet during surgery procedure. Does this become a contributing factor to any variables mentioned in Table 2?
- Move Figure 1 after Table 5.
- Explain Table 5 abbreviations.
Author Response
Dear Reviewer1,
Thank you very much for your comments that helped us to improve this manuscript.
In attachment is word file with corrections point by point as requested from MDPI.
The authors welcome further constructive comments if any.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Dear authors,
thank you very much for your hard work in preparing and conducting this research. Indeed this is an interesting topic.
However, I have difficulties to follow your manscript throughout. In the methods section you describe two cohorts, but later you do not follow up these cohorts. Instead you compare the preoperative anemia group vs the non PA group across a time-frame of 5 years. In this time a lot of things might have changed (e.g. surgeons, their approach and many more).
This is confusing. Further do you cluster TKA and THA although both are different (also in regard to bleeding).
It is not clear which group is followed and for how long. You do not report the co-morbidities of the patients and their chronic medication. This might be important.
All sections need a deep revision to create a homogenous work.
I send your paper as pdf with my comments and hope it will reach you for your support.
Best regards
Comments for author File: Comments.pdf
Author Response
Dear Reviewer #2,
We appreciate the reviewer’s insightful suggestion and agree that it would be useful to make major revision of manuscript. Thank you very much for agreeing with us to the intention of this manuscript. We have read your comments carefully and tried our best to address them one by one, especially in terms of corrections in methods and other chapters. We do our best to make deep revision and to create a homogenous work.
After your valuable suggestions we send manuscript to native English-speaking colleague and also include his editing in final version of the text.
In attachment is word file with corrections point by point as requested from MDPI.
We hope that the manuscript has been improved after this revision.
Best regards.
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
Dear authors,
thank you very much for your quick changes. The quality of the manuscript is clearly improved.
At this stage I have only some minor comments (see pdf)
Comments for author File: Comments.pdf
Author Response
Dear Reviewer #2,
Thank you very much for your hard working on reviewing this manuscript. All grammar errors have been corrected as proposed. All changes can be monitored in track changes option.
Point 1: Line 329. is there study performed in orthopaedic surgery, which looked at erythropoietin and iron, if so, you should refer and compare your data.
Response 1: Thanks for your question. You are absolutely right. There are many studies concerning i.v. iron and erythropoietin. In our study we did not observe outcomes, nor have access to such data. We cited reference only as recommendation.
Point 2: Line 380. Would such patients benefit from viscoelastic test and coag-factors if needed?
Response 2: Thanks for your question. Sadly, in our institution there is only standard laboratory testing which do not monitor effect of LMWH. Of course, the effect of LMWH can be monitored with calibrated anti-Xa test and ClotPro RVV test. Maybe in future we will obtain such tests.
We also correct links to references in text and checked them again.
Best regards
Author Response File: Author Response.pdf
