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17 - Assessment of bleeding risk in the patient with no history of hemostatic problems

Published online by Cambridge University Press:  12 January 2010

By
Eve Rodler  and
Ted Wun
Edited by
Michael F. Lubin ,
Robert B. Smith ,
Thomas F. Dodson ,
Nathan O. Spell  and
H. Kenneth Walker
Eve Rodler
Affiliation:
Robert Wood Johnson School of Medicine, Camden, NJ
Ted Wun
Affiliation:
Division of Hematology Oncology, UC Davis SOM VA Northern California Health Care System, Sacramento, CA
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Robert B. Smith
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Nathan O. Spell
Affiliation:
Emory University, Atlanta
H. Kenneth Walker
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

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, 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 provide a reasonable basis for selecting laboratories for individual patients. Level 1 are patients with a reassuring history who are undergoing surgeries with only minimal potential blood loss such as excisional biopsies or dental extractions.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 219 - 229
Publisher: Cambridge University Press
Print publication year: 2006

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