Tuesday, November 25, 2008

Surgery in CLL patients

CLL mpatients have to have operations just like anybody else. Are they at particular risk? The answer is no, not unless they have reduced platelets or reduced neutrophils. The reduced immunoglobulins or T cell deficiency do not come iinto play. Surgeons always take account of the platelet count and set their own safety levels according to the type of surgery. If the neutrophil count is less than 1 then either G-CSF or prophylactic antibiotics may be necessary.

The particular operations that CLL patients are subject to are, bone marrow biopsy, for which no special precautions are necessary, lymph node biopsy, which is usually safe if superficial, though a deep lymph node may require platelet cover, and splenectomy. If possible I recommend laparoscopic splenectomy as teh blood loss is usually less. An open operation does carry greater risk and in this circumastance particular attention must be paid to platelet and neutrophil counts.


Anonymous said...

Is it just me, or does it seem there are fewer splenectomies being performed these days?

tricia gardom said...

Thank you for this timely post. I will be having surgery in the New Year and the post removes one anxiety. My blood count continues to be normal but could you remind me when it is important to use Irradiated Blood for transfusions in patients who have had chemotherapy. I was treated with Epirubicin and CMF in 2006/7 for breast cancer.

Terry Hamblin said...

Irradiated blood is needed in patients who have had either fludarabine or Campath in the past and in those have allografts or autografts.