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Preoperative laboratory testing

There are no formal guidelines for preoperative laboratory testing. Individual decision should be based on the medical condition of the patient and nature of surgery, considering the potential for blood loss and other hemodynamic perturbations. The following are recommendations to guide perioperative laboratory testing.

  1. CBC and Hct- check in patients undergoing surgery with potential for blood loss or trauma. Other medical comorbidities in which CBC may be useful include a history of bleeding disorders or anticoagulant use, kidney disease, recent cancer treatment in form of chemotherapy or radiation treatment, corticosteroid therapy, poor nutritional status.
  2. Renal function – indicative of fluid imbalance as in seen in dehydration or volume overload, disease states in which kidney function might be affected such as diabetes, hypertension, cardiac disease, and renal disease including transplant, liver disease, relevant recent chemotherapy (e.g. cisplatin, carboplatin), and nutrition problems such as anorexia
  3. Liver function tests – history of liver disease including tumor, hepatitis, jaundice, cirrhosis, portal hypertension, biliary or gallbladder disease, hepatotoxic drug exposure, and coagulation disorders
  4. Coagulation tests – known bleeding disorder, previous excessive intraoperative surgical bleeding, hepatic disease, poor nutritional status, and use of anticoagulants or other drugs that affect coagulation.
  5. Urinalysis- suspected urinary tract infection or unexplained fever or chills.
  6. ECG – history of CAD, hypertension, diabetes, congestive heart failure, and stroke or clinical symptoms including chest pain, palpitations, syncope, dizziness, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea and auscultation of murmurs.
  7. CXR – findings on physical examination (e.g. rales, rhonchi), medical problems including COPD, suspected pulmonary edema, pneumonia, lung or mediastinal masses, aortic aneurysm, cardiomegaly, pulmonary hypertension.