Haematology of Peri-operative Care

Question 1

What 3 aspects of the blood must be considered when peparing a patient for surgery?

Answer 1

• What is the oxygen carrying capacity?
• How much will the blood clot?
• How many white cells are present?

Question 2

What test can be used to assess the blods oxygen carrying capacity?

Answer 2

FBC

Question 3

If a patient is not anaemic what other test should be ordered prior to surgery?

Answer 3

Group and save

Question 4

If the patient is not anaemic but there is a high bleeding risk what blood test should be ordered in the place of a G&S?

Answer 4

Cross-match

Question 5

If the patient is anaemic and the surgery is elective, what actions should be taken?

Answer 5

• Correct the anaemia (either by treating the underlying cause (if enough time) or replacing with blood transfusion)
• Once corrected proceed as in non-anaemic patients

Question 6

If an anaemic patient require immediate surgery what actions should be taken?

Answer 6

• Group and cross-match and consider transfusion if needed
• If the patient is actively bleeding secure their haemodynamic stability

Question 7

What surgical risks does anaemia carry?

Answer 7

• Increased risk of bleeding
• Poorer wound healing
• Greater mortality/morbidity

Question 8

What procedures have a high bleeding risk?

Answer 8

• Cardiothoracic surgery
• Urological surgery
• GI surgery
• Vascular surgery
• Liver/spleen surgery

Question 9

How can poor clotting be investigated?

Answer 9

Coagulation screening

(only really used if the patient’s history suggests need)

Question 10

What aspects of a patient’s history suggests the need for a clotting screen?

Answer 10

• Family/personal history of clotting disorders
• Unusual bleeding
• Previous post-surgical bleeding
• Emergencies

Question 11

How is risk of hypercoagulability (VTE risk) assessed?

Answer 11

Asses for risk factors e.g.:

• Age
• Thrombophilia
• BMI
• Previous history of threomboembolism
• Long procedures
• Orthopaedic procedures
• Cancer

Question 12

How should aspirin monotherapy be handled when a patient is going for surgery?

Answer 12

Continue as normal

Question 13

How is clopidogrel monotherapy managed when a patient needs surgery?

Answer 13

Most surgeons will want to stop but this should be discussed with prescriber first

Question 14

How is clopidogrel/aspirin dual therapy managed when a patient requires surgery?

Answer 14

Leave alone

Question 15

If a patinet requires warfarin what procedures can still go ahead without stopping the medication?

Answer 15

• Minor skin surgery
• Dental extraction
• Cataract surgery

Question 16

If a patient’s normal INR target is 2-3, when should warfarin be stopped?

Answer 16

5 days before surgery

Question 17

If a patient’s normal INR target is 3-4, when should warfarin be stopped?

Answer 17

6 days before surgery

Question 18

What is the target INR for most operations?

Answer 18

<1.5

Question 19

How can the patient’s immune status be assessed prior to surgery?

Answer 19

WCC (FBC)

Question 20

What should be looked for on a WCC in particular?

Answer 20

Neutropenia

Question 21

What is a group and save?

Answer 21

The patinet’s blood group is identified and stored in case of need for transfusion

Question 22

What is cross-match?

Answer 22

Where the patient’s blood is matched to an exiting blood unit available in the blood bank, usually performed when transfusion is certain or highly likely