Surgery in acute leukemia: A review of 167 operations in thrombocytopenic patients

Of 435 consecutive patients with acute leukemia, 95 patients had 167 operations with a platelet count of < 100 × 10⁹/L and 130 operations with platelet counts of < 50 × 10⁹/L. Only 7% of operations had intraoperative blood loss of >500 ml, and 7% required >4 units of red cells transfused in the perioperative period. No patient died of bleeding attributable to surgery within 1 month of the operation. Granulocyte count was <0.5 × 10⁹/L in 66% of operations with 57% febrile preoperatively. However, no patient developed infection within the surgical field in the postoperative month. Logistic regression analyses were used to assess preoperative factors, which identified those operations at risk for excessive bleeding or postoperative surgical complications. Major (group 1) operations, preoperative fever, and preoperative coagulation abnormalities were associated with operations with an intraoperative blood loss >500 ml and/or perioperative red blood cell RBC transfusions >4 units (P < .001). Surgery in cytopenic patients with acute leukemia is safe provided optimal supportive care is available.