••• CHAPTER 34^ Preoperative Evaluation and Preparation of Gynecologic Surgery^347
❍ How should a patient be evaluated when the platelet count is discovered to be <100,000/mm^3?
An etiology should be sought, and a bleeding time should be obtained.
❍ What is the most common inherited condition leading to platelet dysfunction?
von Willebrand disease.
❍ What is the role for preoperative screening for coagulation defects?
Only seriously ill patients and those with history of bleeding should be tested.
❍ What are the two most common causes of thrombocytopenia?
Laboratory error and collagen vascular diseases.
❍ What medications have been shown to cause platelet dysfunction?
Aspirin, amitriptyline, nonsteroidal anti-inflammatory agents, and high doses of penicillin and carbenicillin.
❍ When patients are noted to have increased bleeding times due to medications, what should be done in the
preoperative period?
The medications should be discontinued for 7 to 10 days before undergoing surgery.
❍ What is the most common method of diagnosing a platelet dysfunction?
By history and physical examination (easy bruisability, sustained bleeding from cuts, bleeding with brushing teeth,
petechiae on examination).
❍ How do platelet counts correlate with surgical hemorrhage?
A platelet count above 100,000/mm^3 is adequate for surgical hemostasis.
❍ What preoperative granulocyte count is associated with surgical morbidity?
< 1000 /mm^3.
❍ What are the most common etiologic factors leading to end-stage renal disease?
Glomerulonephritis, hereditary factors (eg, polycystic kidney disease), and renovascular disease like diabetes and
hypertensive disease.
❍ What type of anemia is the most common in patients with renal insufficiency?
Normocytic normochromic.
❍ What measures may be employed for patients with renal insufficiency and anemia?
Recombinant erythropoietin can help correct the anemia if surgery can be delayed for several weeks.
❍ What preoperative measures can reduce coagulation problems in patients with chronic renal insufficiency?
Cryoprecipitate, desmopressin, and conjugated estrogen have been given to shorten the bleeding time.