The Medical clinics of North America
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Med. Clin. North Am. · Jan 2003
ReviewEvaluation and management of anemia and bleeding disorders in surgical patients.
The perioperative period offers a unique hemostatic and physiologic challenge. Evaluation of anemia and the decision to transfuse play an important role in the perioperative period. ⋯ A bleeding-oriented history and physical, along with some baseline tests, may help alert the physician to the possibility of a bleeding disorder. Finally, some patients may need correction of their bleeding disorder before surgery or careful monitoring in the perioperative period.
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Preventing postoperative ARF, especially in subjects with pre-existing chronic kidney disease, and caring for ESRD patients undergoing surgery are challenging and best accomplished by a team comprised of primary care physician, nephrologist, cardiologist, surgeon, anesthesiologist, endocrinologist, and nutritionist. Elimination of risk factors for ARF whenever possible, as well as early diagnosis, may improve the outcome of this devastating illness. Drugs capable of preventing or changing the course of postoperative ARF may be available soon. For uremic patients, a comprehensive approach is necessary to minimize morbidity and mortality imposed by numerous comorbid conditions.