L. Anewenah1, M. Asif1, M. Rasouli1, O. Domingo1 1Mercy Catholic Medical Center,Department Of General Surgery,Darby, PENNSYLVANIA, USA
Introduction:
The thyroid and parathyroid glands are among the most highly vascularized tissue beds. As a result, bleeding from these glands can be life threatening. While approximately only 1% of postoperative bleeding is observed in these procedures, it is common practice to perform type and screening of patients undergoing these procedures.
The purpose of our study is to review records of thyroid and parathyroid procedures performed at our Institution from the beginning of 2012 to the end of 2014 and of that number how many went on to need blood transfusion. We also hope to be able to identify the characteristics of the patients who had postoperative bleeding to inform policy regarding type and screening test for patients undergoing these procedures.
Methods:
This is a retrospective study of patients who underwent thyroid and parathyroid procedures. Demographic, laboratory results and surgical related data were obtained from querying our institutional database. Descriptive analysis was performed.
Results:
A total 62 patients including 46 females (74%) were included in the study. Mean age of patients at the time of surgery was 55 +/- 13 years.
46 thyroid surgeries (34 total thyroidectomy, 10 thyroid lobectomy, one thyroglossal cyst removal and one completion thyroidectomy) and 16 parathyroid surgeries (3 total parathyroidectomies, 3 left and 3 right parathyroidectomies, 5 single parathyroid gland removal, 1 subtotal thyroidectomy, and 1 exploration of parathyroid) were performed. All surgeries were performed under general anesthesia. Estimated blood loss ranged from 5 to 200 milliliters. Median weight of the removed thyroid gland was 26.3 grams ranged from 2.7 to 409 grams. Median weight of the removed parathyroid gland was 1.5 grams ranged from 0.07 to 10.1 grams. Median length of hospital stay was 1 day ranged from 0 to 28 days.
Preoperative International Normalized Ratio (INR) was high in only three patients, which ranged from 1.4 to 1.5. Only 5 patients (8%) had preoperative platelet counts of less than 150,000 platelet per microliter (ranged from 73 to 139 platelet per microliter). Mean preoperative and postoperative hemoglobin were 12.7 +/- 2.2 g/dL and 11.2 +/- 1.7 g/dL, which was statistically significant (p<0.001).
Type and screen was requested in all cases. Only two patients (3.2%) required postoperative transfusion and 2 units of packed cell transfused in each case (table 1)
Conclusion:
Large volume of blood loss requiring intraoperative or postoperative blood transfusion is extremely rare. For the patients that required a transfusion, the type and screen can be done rapidly and the patients safely transfused. It seems, therefore, that routine type and screen is unnecessary in patients undergoing thyroid and parathyroid.
