Preoperative Management of Patients with Blood Dyscrasias in Orthopaedic Surgery

We reviewed 28 cases with serious blood dyscrasias who underwent orthopaedic surgery, and studied their perioperative management. 10 of the 28 cases were suffering from fractures. 5, 4, 3, and, 3 cases were suffering form tumors, lumber degenerative disorders, infection, and osteonecrosis of the femoral head, respectively. Acute leukemia was the major combined blood disease, which occurred in 9 cases. Idiopathic thrombocytopenic purpura (ITP) was found in 5 cases. We preoperatively gave platelet transfusions to the patients, if laboratory data showed their platelet counts were under 5×104/mm3. High-dose gammaglobulin therapy was an effective treatment for ITP. We managed to achieve platelet counts of over 5×104/mm3 in all patients. Leukocyte poor red cells were used for blood transfusion, if necessary, to avoid graft versus host disease. In all cases, the perioperative course was uneventful.