A 45-year-old man has been diagnosed with polycythemia

Discussion in 'MRCS Forum' started by Lona., Oct 25, 2007.

  1. Lona.

    Lona. Guest

    A 45-year-old man has been diagnosed with polycythemia vera. He has chronic cholelithiasis and repeated episodes of cholecystitis. A cholecystectomy is planned. Which of the following is not true?
    a- The most frequent complication is likely to be intraoperative and postoperative hemorrhage
    b- Fresh frozen plasma should be infused before surgery
    c- Phlebotomy should be performed to a Haematocrit of 48% or less
    d- Platelets should be brought to a level of less than 400,000
    e- Emergency surgery should be preceded by dilution with Ringer’s lactate to normal Haematocrit and platelet levels
  2. Lona.

    Lona. Guest

    Answer: b- Fresh frozen plasma should be infused before surgery. (Schwartz, 7/e, pp 85-87) Intraoperative and postoperative hemorrhage is a significant problem in the patient with polycythemia vera. Despite Thrombocytosis, these patients have a hemorrhagic tendency generally ascribed to a qualitative deficiency of platelets. Elective surgery should be postponed until the hematocrit and platelet count reach normal levels. Alkylating agents, such as busulfan or Chlorambucil, are effective in this regard. In the emergency situation, phlebectomy should be performed prior to operation and also an especially careful hemostatic technique should be employed. Infection is also a problem in patients with polycythemia vera, but hemorrhagic problems are the more frequently encountered complications.

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