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Acute iatrogenic polycythemia induced by massive red blood cell transfusion during subtotal abdominal colectomy

David Chiapaikeo, Pejman Rohani
  • David Chiapaikeo
    Department of Surgery, Monmouth Medical Center, Long Branch, NJ, United States |
  • Pejman Rohani
    Department of Surgery, Jersey Shore University Medical Center, Neptune, NJ, United States


A 46 year old man was transfused ten units of packed red blood cells during subtotal colectomy after intraoperative point-of-care testing values demonstrated hemoglobin values less than seven grams per deciliter (g/dL). A post-operative hemoglobin analyzed in a standard hematologic laboratory revealed a hemoglobin value of 27.8 g/dL. He underwent emergent red blood cell depletion therapy which decreased his hemoglobin to 7.5 g/dL. The physiologic consequences of iatrogenic polycythemia caused by massive transfusion during major abdominal surgery must take into account the fluid shifts that interplay between the osmotic load, viscosity of blood, and postoperative third spacing of fluid. Treatment of acute iatrogenic polycythemia can be effectively accomplished by red blood cell depletion therapy. However, fluid shifts caused by massive transfusion followed by rapid red cell depletion produce a unique physiologic state that is without a well-described algorithm for management.


polycythemia, massive transfusion, colectomy, point-of-care test

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Submitted: 2014-09-17 04:53:36
Published: 2015-03-23 09:12:30
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