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INTRODUCTION

Hematologic disorders are diseases of circulating blood cells and plasma proteins that play a role in oxygen delivery, inflammation, infection control, hemostasis, and thrombosis. Given that surgery can result in bleeding and induce hemostatic changes that promote thrombosis, it is not surprising that patients with hematologic disorders present serious preoperative management challenges. The ability of hospitalists to manage diseases associated with blood disorders, and hemostatic and thrombotic risks associated with surgery is vital to the welfare of these patients. This chapter will discuss preoperative assessment of patients with hematologic disorders, and review the risk of perioperative hematologic complications and specific management strategies to reduce perioperative risks in this vulnerable patient population.

PREOPERATIVE ASSESSMENT OF PATIENTS WITH HEMATOLOGIC DISORDERS

HISTORY AND PHYSICAL EXAMINATION

The most important aspect in the preoperative assessment of patients with a hematologic disorder is a thorough history. This is especially true for patients with hemostatic disorders (Table 54-1). Though the patient may have a known hemostatic diagnosis, the clinical phenotype of these patients may vary considerably. Occasionally, a patient may report an unexpected personal and/or family history of bleeding or thrombosis, or a hematologic diagnosis as a child with no subsequent follow-up. Depending on the severity of the presumed diagnosis, these subjective accounts may need to be confirmed objectively. The physical examination is rarely helpful in such situations. However, the presence of petechiae, purpura, ecchymoses, jaundice, ascites, and splenomegaly may alert one to the presence of potential hematologic disorder.

TABLE 54-1Recommended Questions to Ask in Patients with Known or Suspected Hemostatic Disorders

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