• SDN Site Updates

    Hey everyone! The site will be down for approximately 2 hours on Thursday, August 5th for site updates.

What do you do

  • Delay case, send to heme for work up

    Votes: 8 36.4%
  • Phelbotamize and/or hemodilute to a hct that makes you feel better

    Votes: 4 18.2%
  • Mine are brass, don't delay, don't consult, proceed

    Votes: 10 45.5%

  • Total voters
    22

MTGas2B

Cloudy and 50
15+ Year Member
Sep 22, 2004
917
55
upper left
Status (Visible)
  1. Attending Physician
Thoughts on this one. 60 something woman scheduled for elective surgery to investigate a thoracic incidentaloma. Pre-op hct comes back at 56. Last hct in EMR in the 40s a few years ago. Assume this isn't lab error, and repeat lab is unchanged at 56.

What do you do?
 

MTGas2B

Cloudy and 50
15+ Year Member
Sep 22, 2004
917
55
upper left
Status (Visible)
  1. Attending Physician
Well, I guess this wasn't that exciting of a case. So, literature is lacking on what to do. I did stumble across this VA study that happened to look at hcts and surgery. They looked at both ends of the spectrum, anemia, and polycythemia and 30 day mortality. Relative to the size of their retrospective cohort there really weren't that many patients with polycythemia, but as they point out, more than anyone else has published. And what did they find, when hct gets beyond 51 mortality starts to increase. They really don't explain causes of mortality.

Now, in the case I mentioned, how applicable is this? The JAMA study is pretty much all dudes, and its retrospective. Not great, but really not much out there to go on, except, "I've never had a problem polycythemia in the perioperative period, so it must be fine." But, to be fair, does taking action on it do anything? No one knows.

I guess I would favor heme evaluation for elective surgery if it can wait, although there may not be much to do for secondary polycythemia in a smoker, which many of these probably are. And I would consider active measures for surgery that can't wait based on likely blood loss, other comorbidities, (CAD, CVA, etc) and I would consider measures such as autologous blood donation for the phlebotomy benefit.
 

Attachments

  • JAMA-2007-Wu-2481-8.pdf
    118.4 KB · Views: 2
About the Ads
This thread is more than 9 years old.

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.