Kiro Kiranlata, Ganjoo Pragati, Saigal Deepti, Hansda Upendra
Department of Anaesthesiology and Intensive Care, Govind Ballabh Pant Hospital, Maulana Azad Medical College, New Delhi, India.
J Anaesthesiol Clin Pharmacol. 2014 Apr;30(2):281-3. doi: 10.4103/0970-9185.130102.
Preoperative thrombocytosis, often detected incidentally in surgical patients and inadvertently overlooked, has important implications for the anesthesiologists. The primary form is a chronic clonal myeloproliferative disorder usually affecting adults while the secondary type is a benign reactive disease commonly found in children. Serious perioperative hemostatic complications are reported in primary thrombocytosis and hence, a detailed preoperative evaluation and initiation of therapy to lower the platelet count (PC) is required before undertaking surgery. Patients with reactive thrombocytosis however, usually have complication-free surgeries, and if there is no prior evidence of hemostatic complications and the reactive cause can be identified, no specific perioperative intervention may be required. A thorough preanesthetic checkup and implementation of basic thrombo-prophylaxis measures in all patients with a raised PC is advocated. We present here our experience with three infants diagnosed with high preoperative PC, presumably due to reactive causes, who underwent uneventful neurosurgeries at our institution.
术前血小板增多症在外科手术患者中常为偶然发现且易被疏忽，这对麻醉医生具有重要意义。原发性血小板增多症主要表现为慢性克隆性骨髓增殖性疾病，多见于成年人；继发性血小板增多症则是一种良性反应性疾病，常见于儿童。原发性血小板增多症患者围手术期有严重的止血并发症报道，因此，在进行手术前需要进行详细的术前评估并开始降低血小板计数（PC）的治疗。然而，反应性血小板增多症患者通常手术过程无并发症，如果既往没有止血并发症的证据且能确定反应性病因，则可能无需进行特殊的围手术期干预。我们提倡对所有血小板计数升高的患者进行全面的麻醉前检查并实施基本的血栓预防措施。在此，我们介绍在我院接受神经外科手术且手术过程顺利的3例术前血小板计数升高的婴儿的经验，推测其病因可能为反应性。
