Perioperative anaemia

73-year-old man for Right laparoscopic adrenalectomy


  • Large adrenal adenoma – phaeochromocytoma excluded after extensive investigation
  • Cushing’s
  • Hypertension and high cholesterol
  • DASI 6.2 METs


  • New ejection systolic murmur and RBBB noted in clinic
    • Echo – severe AS.
    • Exertional dyspnoea after 30 minutes of mowing. No angina
    • Surgery postponed for Cardiothoracic review
  • AVR with tissue valve 6 months ago, no anticoagulants
  • Recent admission:
    • HB 42 and melaena
    • FBC unremarkable otherwise.
    • Upper GI investigations normal.
    • Transfused to Hb 80. Currently stable.
    • Anaemia screen – negative
    • Colonoscopy – 2 years previously for positive family history. NAD. No repeated as inpatient.
  • Gastroenterology review – working diagnosis of angiodysplasia from AS. For review and possible pill cam as outpatient. Recommended to proceed with surgery if Hb remains stable.



  • Monitor Hb
  • No need for pill cam preoperatively if no ongoing losses
  • Postpone 6/52, surgical team in agreement