If you need surgery

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• Talking with your doctor

You have an MPD that is under good control. You are doing well from day to day – but what if you need an operation? Many people with MPDs feel concerned when facing surgery.

Plan in advance

Whenever possible, it is always wise to do some planning in advance. Tell the doctor or dentist who will be doing your procedure that you have an MPD, even if the procedure you are undergoing will be minor. You may need to take the role of the expert and educate your doctor or dentist about MPDs. Put your dentist or surgeon in contact with your haematologist for further advice.

Evaluate the risk

There are two main concerns, which may appear contradictory. People with MPDs have a risk of clotting, and they also have a risk of excessive bleeding. These risks are present in all surgeries, but are increased when you have an MPD. Your level of risk depends on several factors including what sort of procedure you need. Your surgeon and haematologist need to consider both your own history and the particular operation that you need.

Orthopaedic procedures such as hip replacement are well known to have increased thrombosis risk. In dental surgery, bleeding is more of a concern.

The type of MPD you have also plays a part in determining your level of risk. In a group of MPD patients evaluated for complications after surgery, arterial thrombosis appeared to be more common in patients with ET and venous thrombosis in those with PV.

Understand your options

Your doctor or dentist can consider several options:

• Your blood “stickiness” Your doctor (or dentist) will evaluate whether your blood is more “sticky” and whether you have you already experienced a clot or tend to bleed more.
• Pre-surgery treatments Your doctor may suggest stopping anti-platelet agents such as aspirin for some time prior to surgery, or modifying or switching warfarin (or similar drugs) to heparin for a time. If you are not currently treated with drugs to control your blood count, your doctors may sometimes recommend a course of treatment to normalise your blood count before an operation.
• Post-surgery treatments Your doctor will consider which treatment is most suitable for the type of surgery you are planning. Heparin is often given after hip replacement surgery to prevent clots, but heparin is not needed for dental surgery.

What’s most important

Tell doctors and dentists you have an MPD. Ask them to discuss your procedure with your haematologist, whether the procedure is planned or done in an emergency. Your haematologist will provide advice tailored to your particular situation. We wish you good luck with your procedure.

Your level of risk depends on your condition, your general health and the type of operation you need.