Anesthetic Management of a Patient with Polycythemia Vera for Nephrectomy

Polycythemia Vera (PV) is a chronic myeloproliferative disease, characterized by erythrocytosis and hyperviscosity. A high proportion of PV surgeries are complicated by thrombosis (7.7%) or by a major hemorrhage (7.3%), increasing morbidity and mortality among these patients. We report a 28-year-old male patient with PV and renal cell carcinoma posted for nephrectomy. He was found to have a hematocrit of 68% on routine work-up. Preoperatively he was phlebotomized 4 times to decrease hematocrit to 48%. Perianesthetic considerations and anesthetic management of this patient are discussed. Pretreatment of PV with phlebotomy, adequate hydration, and recognition of thrombotic and bleeding problems decreases perioperative morbidity and mortality and are the keystones in the successful anesthetic management of such patients.