Perioperative normovolemic hemodilution in a case of leiomyomatous erythrocytosis

A 66-year-old female patient presented with complaints of abdominal discomfort, pigmentation and numbness of both lower limbs for 3 years duration. On examination, she had erythema of the face and palms. Investigations revealed high hemoglobin (Hb), hematocrit (Hct) and erythropoietin. Ultrasonography abdomen showed large uterine fibroid. As there are increased tendencies of thromboembolic episodes in patients undergoing surgeries with such high Hb and Hct, a target to achieve a Hb of 15g/dl and Hct of 45 was set in the patient. Repeated phlebotomies were done over 10 days with oral hydration only and the Hb was brought down to 18 g/dl on the day prior to surgery. On the day of surgery, pre-operative phlebotomy was done so as to remove 2 units of 350 ml blood and was transfused intraoperatively to combat blood loss. Post-operatively Hb was 12.4 g %. Patient was discharged on the 10(th) post-operative day with further follow-up evaluations being uneventful.