EMERGENCY-SURGERY IN HEMATOLOGIC PATIENTS

Patients at risk for clinically significant bleeding and who require u rgent or emergent surgical procedures are encountered, Usually local c auses are responsible, but a generalized hematologic defect may be unc overed, Quickly and effectively distinguishing the cause may he critic al to rapid treatment and survival. A careful history, appropriate use of laboratory tests (e.g., partial thromboplastin time, prothrombin t ime, and platelet count), and knowledge of possible causes are keg to prompt diagnosis and treatment. Bleeding from multiple sites, spontane ous bleeding, or unexpectedly severe bleeding suggests a systemic proc ess, Immunocompromised or suppressed patients or systemically ill pati ents with chronic hepatic renal, lymphatic, and hematologic disorders are seen with urgent surgical problems. The key is rapid diagnosis and effective systemic and local therapy to counter the problem. The synd rome of diffuse ''medical bleeding'' frequently confronts the surgeon treating a patient who has received transfusions of more than 1.5 time s blood volume, The coagulation defect is almost always associated wit h hypothermia and acidosis. Treatment consists in control of large-ves sel bleeding by appropriate surgical techniques, blunt packing, and ta mponade of diffuse bleeding, rapid rewarming of the patient, and adequ ate resuscitation for shock. Transfusion of platelets and fresh frozen plasma is empiric initially and subsequently guided by the clinical a nd laboratory coagulation profiles of the patient.