If you need surgery

Whenever possible, plan ahead with your haematologist and surgeon.

Even if you have a myeloproliferative neoplasm (MPN) that is under good control and are doing well from day to day there may be an occasion where you may need an operation. Understandably, many people with MPNs feel concerned when facing surgery. Here are some tips on how to prepare for surgery.

Plan in advance

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

Evaluate the risk

There are two main concerns, which may appear contradictory. People with MPNs 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 MPN. 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. But all surgical procedures need to be considered carefully.

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

Understand your options

Your surgeon or dentist can consider several options:

  • Your blood “stickiness” Your surgeon or dentist will evaluate whether your blood is more “sticky” and whether you have already experienced a clot or tend to bleed more.
  • Pre-surgery treatments Your surgeon 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 surgeon 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

Always tell surgeons and dentists you have an MPN.  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 well with your procedure.