Low Hemoglobin of 9.4 okay for tummy tuck?

Question

I'm scheduled to have a extended tummy tuck on 6/29 with Dr. Robert Hunsaker. My preop labs since March 2017 have been coming back with low hemoglobin. As of 3/25/17 it was 9.2, on 6/7/17 it was 9.5 and has of 6/21/17 it's 9.4. I'm currently on iron, folic acid and b-12. My surgeon stated he is okay with moving forward with my plan surgery. I just would like some second opinions.

Shlomo Widder, MD · Answer

Dear sweetlife,   I had similar case this week and I canceled surgery. I referred the patient to an internist , to find out the reason for the anemia and bring the hemoglobin level to, at least,  above 10 .  Cosmetic surgery is purely elective surgery and risk should be reduced to a minimum. Hemoglobin of 9.4 is not healthy level and most likely, it will be even lower after the tummy tuck surgery. It is wiser and safer for you to wait 4-6 week , so the investigation of your anemia will be complete and your hemoglobin level will be more compatible with healthy outcome. Most likely you are a mother and your safe outcome is important for the care of your children as well .           Remember, an ounce of prevention is better than a pound of cure.                            Best of luck,                                               Dr Widder

Robert L. Kraft, MD, FACS · Answer

I would consider 9.4 to be below the minimum for an abdominoplasty. It is a longer operation and blood loss would be involved.  A hematologist should be involved in the medical clearance process and, ultimately, I accept their superior knowledge of anemia and safety concerns, as does my anesthesia team.

Sanjiv Kayastha, MD · Answer

There is no absolute answer to this question. I prefer to see a hemoglobin level of 10 for any procedure  where there could be anything more than a minimal blood loss. Starting with a low hemoglobin increases the chance that you may require a transfusion if there is significant blood loss. Be aware that while transfusions are generally safe, they do have risks.

William B. Rosenblatt, MD · Answer

My limit is 10. If you are being done in a hospital and would accept transfusions then go for it. Otherwise I would speak to the correct doctor to get your levels higher. Usually with a tummy tuck there is more blood loss than you think and although it is uncommon to need blood. Sometimes it happens.

Steven Wallach, MD · Answer

Each doctor may have different criteria for acceptance to move forward with surgery.  Anemia can increase the risk of complications, and tummy tucks and body lifts often have a fair amount of blood loss.  Good luck.

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns a few days before tummy tuck surgery. Ultimately, your plastic surgeon will make the decision whether or not it is safe to proceed; much will depend on exactly what is planned during the procedure and what the anticipated blood loss is. For example, if a significant amount of liposuction surgery is planned, you may be best off postponing surgery.
Hopefully, you have had a workup to determine the CAUSE of the low hemoglobin level you are starting with. If not, seek consultation with an internist or your primary care physician prior to proceeding.
 Best wishes.

Brooke R. Seckel, MD, FACS (retired) · Answer

A full tummy tuck usually accompanied by liposuction is a significant surgical procedure which can cause significant bleeding in some cases.  In my opinion a normal hemoglobin and hematocrit  is necessary before I would contemplate such a procedure. For women this is a 12-15.5.  I would continue the supplements that you are taking and think seriously about delaying your operation.

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