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Chapter 21 - Perioperative management of hemostasis

from Section 6 - Hematology

Published online by Cambridge University Press:  05 September 2013

By
Mrinal Dutia ,
Eve Rodler  and
Ted Wun
Edited by
Michael F. Lubin ,
Thomas F. Dodson  and
Neil H. Winawer
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
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Summary

There is perhaps more money wasted and blood unnecessarily shed in this setting than in any other in medicine.

Sabiston's Textbook of Surgery

Summary

When patients are evaluated for the potential of abnormal bleeding before surgery, the intensity of screening is determined by the hemostatic challenge of the procedure and the likelihood that the patient has an underlying congenital or acquired disorder that would predispose to bleeding. The risk of bleeding associated with the type of surgical procedure ranges from low risk (lymph node biopsies, dental extractions), to moderate risk (laparotomy, thoracotomy, mastectomy), to high risk (neurosurgical, ophthalmic, plastic, cardiopulmonary bypass, prostatic, and surgery to stop bleeding). A screening history should reveal if the patient has experienced any abnormal bleeding or bruising, if there is a history of an acquired medical disorder which could affect hemostasis, if family members have bled abnormally, or if the patient is taking any drugs which could interfere with hemostasis. Physical examination can also provide important information about a patient's surgical bleeding risk. Ecchymoses, petechiae, or purpura may suggest a systemic hemostatic defect. Stigmata of chronic liver disease include hepatomegaly, splenomegaly, jaundice, spider angiomas, palmar erythema, and dilated abdominal veins.

The preoperative hemostatic screening recommendations by Rapaport, based on levels of concern, provide a reasonable basis for selecting laboratories for individual patients [1]. Nearly 30 years old, these recommendations are not obsolete.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 223 - 233
Publisher: Cambridge University Press
Print publication year: 2013

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