A 66-Year-Old Man With Potential Bleeding Complications: Is Surgery Still an Option?

Introduction. A 66-year-old man is being evaluated for elective, outpatient surgery on his left elbow.

History. Approximately 30 years prior, the patient sustained a traumatic fracture of his left elbow that required surgical repair that included surgical screws. In recent months, the patient has felt discomfort in the elbow with certain motions, and he noted that he can feel the presence of a hard body in the elbow area when flexed. Imaging confirmed that one of the screws had broken, resulting in a free-floating foreign body in the elbow. He is scheduled for same-day outpatient surgery using light general anesthesia.

Laboratory examination. Although the patient’s personal medical history was otherwise unremarkable, because of his age, clinicians performed a complete blood count and comprehensive metabolic panel, which fell within normal ranges. The patient’s platelets and prothrombin time test with an INR were within normal range as well. The one outlier was the patient’s partial thromboplastin time (PTT) of 84 seconds (normal PTT, 26 to 36 seconds).

The patient was contacted via phone, and a more detailed history revealed no prior history of abnormal bleeding, either spontaneous or with trauma, following a splenectomy as a teenager, nor following an appendectomy, his previously mentioned elbow surgery, and the extractions of at least two permanent teeth. There is no family history of bleeding dyscrasia.