General Medical Information

Intraoperative and Postoperative Bleeding

David M. Barrs

The most common cause of intraoperative or postoperative bleeding problems, other than an unsecured vessel, is a qualitative platelet disorder. Other possibilities include acute intraoperative hemolysis, sepsis, DIC, and medications used during surgery. Routine laboratory tests, including hematocrit, PT, PTT, and platelet count, should be performed. A bleeding time, fibrinogen level, and fibrin degradation products should also be obtained to help evaluate the possibility of a qualitative platelet disorder or a consumptive coagulopathy. Increased fibrin degradation products (>8 mg/mL) occurs in DIC, thromboembolic events, and fibrinolysis. Fibrinogen levels are below the normal level of 200 to 400 mg/100 mL when the fibrinogen is abnormally depleted in consumptive coagulopathy. Intraoperative treatment revolves around replacement of blood and specific factors if a factor deficiency can be identified, meticulous hemostasis in the operative field, and completion or abortion of the surgical procedure as soon as possible. Fresh frozen plasma and platelets can be used in urgent situations of bleeding. Treatment of the precipitating condition is the major therapeutic goal in DIC. In the postoperative period, a search can be performed for specific causes while replacement therapy is continued for persistent bleeding.