Hemoglobin 8.5 g/dl & rhinoplasty. Should I be concerned?

Question

I have a rhinoplasty scheduled in a few days. I mentioned in my history that I have anemia and asked multiple times if any testing is required. However, surgeon said there was no need for any tests. Being extra cautious I decided to get my blood tested. Results came back with hemoglobin 8.5 g/dl. My primary physician said she cannot advise in regards to the surgery. But she sent the results to the plastic surgeon as she was concerned. She said it would be a plastic surgeons call. Please advise

Eric M. Joseph, MD · Answer

Normal hemaglobin levels start at 11, and a transfusion of 1 unit of packed red blood cells would raise hemaglobin by 1. You are 2 and 1/2 units low, and this should be worked up to determine why you are quite anemic. This should be done BEFORE your rhinoplasty for many reasons. If you are anemic from heavy menses, iron supplements and a consultation with your GYN may be helpful. If you do not have excessive uterine bleeding as a cause for your anemia, you may need to consult with a hematologist (blood specialist) for a workup. If a hematology workup is inconclusive, please make sure a test of your stool for is performed to ensure you have no internal bleeding - the screening test for occult blood in stool is called a Guiac test, and if it's positive, GI endoscopy may be necessary. I hope this helps you. Dr Joseph

Daniel Barrett, MD · Answer

Dear Cheerful900480,
every plastic surgeon has his own preoperative protocol which he recommends to his patients. I would suggest you to discuss this with your plastic surgeon.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ronald J. Edelson, MD · Answer

If you want to play it safe it wouldn’t be a bad idea to go on iron supplements and recheck the labs. On the other hand most surgeons would think it’s okay to proceed with rhinoplasty.

Robert Ciardullo, MD · Answer

Is a hemoglobin of 8.5 too low for rhinoplasty? With a hemoglobin of 8.5 there is no room for any further blood loss. It is not too uncommon for young women to run low blood counts. Some have very heavy menses others have congenital disorders which causes chronic anemia. While this is not a terribly serious condition under normal circumstances, with the potential additional blood loss of surgery the hemoglobin could drift dangerously low. Since rhinoplasty is an elective procedure, the safest and wisest thing to do would be to postpone the surgery and see a hematologist. I have confronted the situation many times in my practice and it usually involves postponing surgery for about six weeks while the patient went on iron and other supplements during which time the blood count rose to a more acceptable range of 11 to 12 or at least 10 to 11

Behrad Elmiyeh, MBBS, MRCS, FRCS (ORL HNS) · Answer

Thank you for your question.
Normal Hemoglobin range is from about 12 to 15 g/dl. You should first be investigated for the cause of anaemia and recieve treatment prior to your surgery. It is not advisible for you to undergo a non-emergency surgery when you have increased risks of surgery and general anaesthesia due to your anaemia. 
Best wishes,

Samir Shureih, MD · Answer

Good for you "being extra cautious" and getting your blood work.
In my practice all major surgery require full blood work and primary care clearance for patient safety.
You seem to have Anemia, low hemoglobin. Surgery should be postponed and you need to go back to your primary care physician and would need full workup for anemia. Personally i would advice not to treat yourself by any supplements rather follow your primary care advice and instructions.

Darryl J. Blinski, MD · Answer

I can only respond if you were my patient. I would cancel you until the cause fr a very low Hb or your anemia is determined. The general medical condition out weighs having any elective surgery in most circumstances.

Jeffrey C. Hamm, MD - Account Suspended · Answer

Hi and welcome to our forum!
As a rhinoplasty procedure may be associated with a moderate degree of blood loss, a preoperative hemoglobin of 8.5 is of concern. If a workup for anemia has not already been completed, it should be accomplished and appropriately treated BEFORE the surgical intervention. 
Best wishes...

Hemoglobin 8.5 g/dl & rhinoplasty. Should I be concerned?

Answers (8)

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