PRE-OPERATIVE ASSESSMENT ON A PATIENT FOR LAPAROSCOPIC CHOLECYSTECTOMY WITH B12 ANEMIA

Abstract

The pre-operative assessment is an opportunity to identify co-morbidities that may lead to patients’ complications during the anesthesia, surgical or postoperative period. Patients scheduled for elective procedures will generally attend a pre-operative assessment 2-4 weeks before the date of their surgery. A woman at the age of 57 years was admitted to the hospital planned for the elective laparoscopic cholecystectomy. On the preoperative assessment on laboratory analysis, we found presence of anemia with MCV levels above normal and low levels of vitamin B12. She was never treated for anemia before. Peripheral blood smear showed presence of macrocytosis. The patient was put on treatment with intramuscular injections of vitamin B12. The operation was delayed for two months. She was admitted to the hospital after two months of treatment and blood analysis were made that showed Hb levels of 115g/l, hematocrit 35%, MCV was 92. She was operated after she had been hospitalized, and laparoscopic cholecystectomy was made without complications. She was released from hospital two days after surgery. The purpose of a preoperative evaluation is not to “clear” patients for elective surgery, but rather to evaluate, and if necessary, implement measures to prepare higher risk patients for surgery. By diagnosing anemia in the preoperative assessment, we reduced the risk of complications during the surgery and during the postoperative period. Early identification and effective treatment of anemia has the potential to improve clinical outcomes in surgical patients.