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What is Pre-Operative Panel? 

The pre-operative panel consists of a group of tests that your doctor will perform right before a surgery - the word pre-operative means before a surgery

It includes the following tests:

  • Blood sugar (random): A random blood sugar test checks the level of a type of sugar called glucose in your blood. This test can be performed at any time of the day. Glucose is your body’s main source of energy. A hormone called insulin helps in the transport of glucose into the cells from blood. If your blood glucose levels are high (hyperglycaemia) or low (hypoglycaemia), it may put you at risk of various conditions and prolong healing after surgery. 
  • ABO incompatibility (blood group and Rh factor): An ABO incompatibility test determines your blood type. It is performed so that you can receive a blood transfusion safely. According to the ABO system, there are four blood types: A, B, AB and O. You inherit your blood group from your parents. A and B are two antigens (proteins) present on the surface of RBCs. Your blood type depends on which of these antigens you have inherited. If you have A antigen on your RBCs, your blood type is A and if you have B antigen on your red blood cells, you have B blood group. If you have neither of them, you are O blood type and if you have both you are AB blood type. This test also checks for another substance known as the Rh factor on the surface of RBCs. Rh factor is either positive or negative. If you are given an incompatible blood type, it may lead to blood transfusion reaction and cause complications. Depending on the incompatibility, blood transfusion reaction can be mild to life-threatening. Read more: Blood group test
  • Complete blood count (CBC): A CBC test is an indicator of your overall health and can check for different conditions, such as leukaemia, anaemia and infections. This test provides information on the following:
    • The type and number of white blood cells (WBCs): WBCs help in fighting infections. They are of five types - neutrophils, eosinophils, basophils, lymphocytes and monocytes. All of the WBCs perform various specific functions. If the WBC count is high or if any specific type of WBC is high, it indicates that you may have an inflammation or infection in the body, whereas if your WBC count is low, it means you have underlying conditions and are at high risk of getting infections. 
    • The number of RBCs: RBCs transport oxygen throughout the body and remove the excess carbon dioxide. If your RBC count is low, it could indicate anaemia or another underlying disease. If your RBCs are too high (rare cases), it could cause problems with blood flow and increase your risk of getting blood clots.
    • Haematocrit (HCT): The haematocrit test determines the percentage of RBCs in your blood. If your HCT results are low, it could indicate iron deficiency or an underlying health disorder. Low haematocrit levels pose a risk of excessive bleeding. If your HCT results are high, it could be due to dehydration or other disorders. Low HCT levels also indicate that your tissues are getting less oxygen. Abnormal HCT may pose a risk of complications in surgery. 
    • Haemoglobin (Hb, Hgb): Haemoglobin is a protein found in RBCs. It carries oxygen to the body from lungs. Abnormal Hb values may be seen in conditions like anaemia and lung disease. Just like low hematocrit levels, low haemoglobin also increases the risk of oxygen deficit in patients and increases the need for blood transfusion during surgery. 
    • Platelet count: Platelets are tiny cells that play a role in blood clotting. A very low platelet count may mean a higher risk of bleeding, while a high platelet count could increase the chances of spontaneous blood clotting in the body.
    • RBC indices: CBC also provides information on the mean corpuscular volume (MCV or the average RBC size), mean corpuscular Hb (MCH or the amount of Hb per RBC) and mean corpuscular Hb concentration (MCHC or the Hb concentration per RBC). These indices help identify what type of anaemia you have so appropriate steps can be taken to manage it.
  • Hepatitis B surface antigen (HBsAg): This blood test determines if you have a recent or long-standing infection from hepatitis B virus (HBV). HBV has antigens (a type of protein) on its surface that cause an immune reaction. These antigens can be found in the blood within several weeks of the infection. The presence of HBsAg is the earliest sign of HBV infection. The virus causes liver infection and is highly contagious.
  • Hepatitis C virus (HCV) antibody: HCV antibody test checks for the presence of special proteins called antibodies in your bloodstream. Antibodies are produced by the immune system to fight infections. Just like hepatitis B, HCV is also contagious.
  • Human immunodeficiency virus (HIV) 1 & 2 antibody: HIV is a highly contagious infection caused by the human immunodeficiency virus. HIV virus is of two types: HIV 1 and HIV 2. The virus attacks and damages the immune system, making the person prone to infections. The HIV test is performed to check if you have been infected by HIV. It looks for the presence of antibodies against the human immunodeficiency virus in your immune system. The immune system takes about three to 12 weeks to produce antibodies against HIV. 
  1. Why is Preoperative testing done?
  2. How do you prepare for Preoperative testing?
  3. How is Preoperative testing done?
  4. What do the results of Preoperative testing mean?

A pre-operative panel is generally done a month before the surgery. The tests provide information about any conditions you may have that could affect the operation. The results of this test determine if your doctor needs to treat any condition you may have. A Pre-operative panel is done even if you otherwise appear to be in good health.

Increased blood glucose levels can raise the risk of postoperative infections, thereby prolonging the hospital stay. Thus, maintaining glucose levels prior to surgery can help in the better management of surgical procedures.

The ABO incompatibility can help in procuring the appropriate type of blood for transfusion if needed during the surgery. The test reduces the risk of any adverse event caused due to the transfusion of the wrong blood type.

Performing the complete blood count can help in detecting conditions like bleeding disorders, anaemia, acquired and inherited blood disorders and the effect of other systemic diseases. These tests help in planning the procurement of blood by arranging for blood products or collecting the individual’s own blood prior to surgery.

The HBsAg, HCV antibody test and HIV 1 & 2 test are performed pre-operatively for the following reasons:

  • The person tested positive can be counselled about the disease and management
  • To prevent the transmission to the surgical team
  • For treatment to the surgical team, if exposed

You don’t need any preparation for most of the tests in the preoperative panel. As most of these tests need a sample of your blood, wear a short-sleeved shirt or T-shirt for the tests to make things easier for the technician while drawing a blood sample.

Inform your doctor about all the medications you are consuming, including vitamins, supplements and herbs.

If you have had any blood transfusion or if you smoke, inform your doctor as these could affect the results of the CBC test.

A technician or your doctor will obtain a few millilitres of your blood by inserting a sterile needle into a vein in your arm. When the technician inserts the needle, you may feel a prick. 

After the sample is obtained, the technician will place it in a labelled bottle and send it to the laboratory for testing. 

You may get a painful bruise at the site of needle insertion. It will fade away in a few days.

Some people also feel lightheaded or dizzy during or after the test, especially those who tend to feel uneasy at the sight of blood.

If the bruise doesn’t fade or if you notice an infection developing at the site, inform your doctor at the earliest. Some signs of infection include redness, swelling and pain at the site and fever.

Normal results:

The normal values for the tests in the pre-operative panel are as follows:

  • Blood sugar (random): The result depends on when you ate last but is usually below 125 mg/dL (milligrams per decilitre).
  • ABO incompatibility (blood group and Rh factor): The test result will show your blood type which could be one of the following:
    • Type A
    • Type B
    • Type AB
    • Type O

The result will also show if you are Rh-positive or Rh-negative based on whether or not you have this cell surface protein. 

Depending on the results, your doctor can decide which blood type you can safely receive:

  • If you have type A blood, you can receive type A and type O blood. 
  • If you have type B blood, you can receive type B and type O blood. 
  • If your blood type is AB, you can receive types A, B, AB and O blood. 
  • If your blood type is O, you can only receive type O blood. 
  • If you are Rh-positive, you can receive either Rh-positive or Rh-negative blood.
  • If you are Rh-negative, you can receive only Rh-negative blood.

The normal results for CBC are as follows:

  • RBC count: 4.7-6.1 million cells/mcL (cells per microlitre) in men and 4.2-5.4 million cells/mcL in women 
  • WBC count: 4500-10000 cells/mcL
  • HCT: 40.7%-50.3% in men and 36.1%-44.3% in women
  • Hb: 13.8-17.2 g/dL (grams per decilitre) in men and 12.1-15.1 g/dL in women 
  • RBC indices: MCV 80-95 femtolitre; MCH 27-31 picograms/cell; MCHC 32-36 g/dL
  • Platelet count: 150000-450000/dL

Normal results of other tests in the preoperative panel are:

  • HBsAg: Normal results are negative or non-reactive and mean that no HBsAg was found.
  • HCV antibody: Normal results are negative and indicate that you do not have the infection.
  • HIV antibody: If the result is negative, it means you do not have HIV. However, negative test results could also mean that a person has HIV, but it is too soon to tell as it takes a few weeks for HIV antibodies to be detectable in the blood. If the result is negative, the doctor may order additional tests later.

Abnormal results:

For the blood sugar (random) test, if the results are 200 mg/dL or more, it generally indicates diabetes. Your blood glucose levels may also be high in some conditions, such as:

You may have hypoglycaemia due to some conditions, such as:

If your RBC, Hb and HCT values are high, it may indicate conditions such as:

  • Lack of enough fluids due to excessive sweating, severe diarrhoea or use of water pills to treat high blood pressure 
  • Lung disease or heart diseases that may lower oxygen levels in the blood 
  • Kidney disease with high production of a hormone called erythropoietin

RBC, Hb and HCT may be low due to anaemia caused by:

  • Blood loss
  • Poor nutrition
  • Long-term conditions like rheumatoid arthritis 
  • Cancer
  • Bone marrow failure (for example, due to radiation, infection or tumour)

The WBC count may be low due to:

  • Alcohol abuse and liver damage
  • Enlarged spleen
  • Bone marrow failure
  • Chemotherapy to treat cancer

The WBC count may be high in conditions like:

  • Infections
  • Diseases like rheumatoid arthritis, allergy or lupus
  • Leukaemia 

An elevated platelet count may be seen in case of:

  • Bleeding 
  • Iron deficiency
  • Diseases like cancer

Decreased platelet count may be due to:

  • Pregnancy 
  • Bone marrow failure
  • Chemotherapy drugs for cancer treatment

For the HBsAg test, if the result is positive or reactive, it indicates that you have an HBV infection. You should generally recover within six months. However, if you do not recover, the virus can cause liver problems. You may need medicines to treat the infection.

If you test positive for HCV antibody, you might have an HCV infection or may have had an infection in the past.

If you test positive for HIV antibody, the doctor will order a follow-up test to confirm the diagnosis. If both tests are positive, then it confirms that you have HIV. However, it does not mean you have AIDS.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

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