Evaluation of hematologic abnormalities in the nonbleeding postoperative patient

With a seriously ill postoperative patient, selecting the best course of action may be difficult when laboratory data suggest hematologic abnormalities. If an Afro-American is to undergo major surgery, simple postoperative screening procedures are available for certain hereditary erythrocyte abnormalities. Acute hemolysis, from any cause, may mimic advanced liver disease. Bleeding into closed body spaces, with erythrocyte destruction secondarily, may mimic generalized hemolysis. One basic premise is always to review the medications being administered; many drugs may induce granulocytopenia or anemia. Because there is a compensatory increase in erythrocyte 2,3-diphosphoglycerate content that increases oxygen release to the tissues in the normovolemic anemic patient, less frequent use of blood transfusion is possible in these patients. Healing will continue even when the packed red cell volume is 25 per cent.