Perioperative management of polycythemia

Jianli Zhao, Liang Huang, David Matson, Na Li, Henry Liu

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Polycythemia indicates an absolute increase in total red blood cell mass. Polycythemia has primary, secondary and mixed types. Polycythemia Vera (PV), a clonal disorder of hematopoietic stem/progenitor cells, is the most common form of primary polycythemias. PV is a neoplasm with gene mutations leading to overproduction of morphologically and functionally normal blood cells. The perioperative complications of polycythemia include thromboembolic events leading to stroke, acute myocardial infarction, and peripheral vascular occlusions. Patients with PV may also suffer from hemorrhagic complications. Patients with PV with low cardiovascular risk can be treated with aspirin and phlebotomy with a target hematocrit <45%, but high-risk patients will necessitate cytoreductive therapy usually with hydroxyurea. Some patients who cannot tolerate or resistant to hydroxyurea will need interferon or Ruxolitinib. Based on current guidelines for the management of PV, most patients can have long and productive lives. The anesthetic considerations for patients with PV should include control hematocrit level to <45% preoperatively, appropriate hemodilution intraoperatively, and closely monitoring hematocrit level and occurrence of potential complications postoperatively.

Original languageEnglish (US)
Title of host publicationEssentials of Blood Product Management in Anesthesia Practice
PublisherSpringer International Publishing
Pages405-409
Number of pages5
ISBN (Electronic)9783030592950
ISBN (Print)9783030592943
DOIs
StatePublished - May 19 2021

All Science Journal Classification (ASJC) codes

  • General Medicine

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