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Perioperative Management of Patients with Rheumatic Disease pp 155–163Cite as

Perioperative Management of the Neutropenic Rheumatologic Patient

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Abstract

Rheumatologic diseases often are complicated by cytopenias. Severe neutropenia may predispose a patient to infections and delayed wound healing. This becomes a special challenge in the perioperative setting. Although neutropenia in the setting of rheumatologic illnesses has many features that are different than those encountered after cytotoxic chemotherapy or in primary bone marrow disorders, the general precautions utilized in patients with primary hematologic disorders still apply.

When a patient with a rheumatologic problem and neutropenia must be taken to surgery, certain concerns arise, depending on the specific procedure. Prosthetic devices are particularly prone to postoperative infections, and a large proportion of procedures in such patients involve joint replacements. Inflammatory bowel disease may coexist with other autoimmune diseases, and surgery for this incurs a risk of perforation and/or abscess formation with a higher risk of postoperative infection. Splenectomy sometimes is required for a patient with rheumatologic problems, such as for some with Felty’s syndrome. Immune disease of skin or blood vessels may be associated with ulcers which heal poorly and which could require procedures. Each of these involves surgery with a potential for serious infection in a patient who is neutropenic.

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  1. Department of Hematology and Blood Disorders, Taussig Cancer Institute of the Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Leonard J. Horwitz M.D.

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  1. Leonard J. Horwitz M.D.
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Correspondence to Leonard J. Horwitz M.D. .

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  1. Department of Rheumatologic, and Immunologic Disease, Cleveland Clinic, Euclid Avenue 9500, Cleveland, 44195, Ohio, USA

    Brian F. Mandell

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Horwitz, L.J. (2013). Perioperative Management of the Neutropenic Rheumatologic Patient. In: Mandell, B. (eds) Perioperative Management of Patients with Rheumatic Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-2203-7_12

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