── HAEMOGLOBIN ──
Hb ≥10: No contraindication. Monitor perioperative blood loss.
Hb 8–10: Optimize if time permits. If urgent, proceed with blood availability and surgical/anesthesia discussion.
Hb <8: Correct before elective surgery unless urgent indication.
HB ≥10 G/DL: PATIENT EVALUATED MEDICALLY. NO ACTIVE MEDICAL CONTRAINDICATION IDENTIFIED FOR PLANNED ELECTIVE SURGERY FROM A HEMATOLOGICAL STANDPOINT. RECOMMEND MONITORING PERIOPERATIVE BLOOD LOSS.
HB 8–10 G/DL:MILD-TO-MODERATE ANEMIA NOTED (HB 8–10 G/DL). OPTIMIZE IRON STORES/HEMOGLOBIN LEVELS IF TIME PERMITS. IF THE SURGERY IS URGENT, PROCEED WITH STRICT BLOOD AVAILABILITY ON STANDBY AND DETAILED SURGICAL/ANESTHESIA DISCUSSION REGARDING FLUID MANAGEMENT.
HB < 8 G/DL: SEVERE ANEMIA NOTED (HB < 8 G/DL). MEDICAL DEFERRAL FOR ELECTIVE SURGERY. CORRECT HEMOGLOBIN LEVELS VIA TRANSFUSION OR INTRAVENOUS IRON THERAPY BEFORE RESCHEDULING, UNLESS THERE IS AN IMMEDIATE LIFE-THREATENING SURGICAL URGENCY.
── THYROID (TSH) ──
TSH 5–10, FT4 normal (Subclinical): No contraindication. Start/adjust thyroid therapy, follow-up.
TSH >10, FT4 normal: Thyroid replacement advised. Clinically stable — may proceed if surgical urgency exists.
Low FT4 / Overt hypothyroidism: Optimize before elective surgery. Defer unless urgent.
TSH 5–10 MIU/L WITH NORMAL FT4 (SUBCLINICAL): SUBCLINICAL HYPOTHYROIDISM NOTED. NO ACTIVE MEDICAL CONTRAINDICATION FOR THE PLANNED SURGERY. RECOMMEND STARTING OR ADJUSTING THYROID HORMONE THERAPY WITH POST-OPERATIVE ENDOCRINE FOLLOW-UP.
TSH >10 MIU/L WITH NORMAL FT4:ELEVATED TSH NOTED. THYROID HORMONE REPLACEMENT IS ADVISED. IF THE PATIENT IS CLINICALLY STABLE AND SURGICAL URGENCY EXISTS, RESECTION/PROCEDURE MAY PROCEED WITH CAUTION.
LOW FT4 / OVERT HYPOTHYROIDISM: OVERT HYPOTHYROIDISM DETECTED. HIGH RISK OF PERIOPERATIVE COMPLICATIONS. OPTIMIZE THYROID STATUS WITH HORMONAL REPLACEMENT BEFORE ELECTIVE SURGERY. DEFER PROCEDURE UNLESS URGENT INDICATION IS PRESENT.
── RENAL (Creatinine) ──
Stable CKD (Cr 1.5–2.5): Proceed with renal precautions, avoid nephrotoxics, hydrate adequately.
Acute rise / AKI: Evaluate and correct before elective surgery.
Severe impairment: Nephrology review and optimization first.
── LIVER (SGPT) ──
Mild (<3× ULN), normal bilirubin/INR: No contraindication. Evaluate cause, avoid hepatotoxics.
Marked (>5× ULN) / Acute hepatitis: Evaluate and stabilize before surgery.
Liver failure (raised INR/jaundice/ascites): Defer elective surgery.
── WBC ──
11,000–15,000, clinically well, afebrile: No contraindication.
>15,000 or suspected infection: Treat infection before elective surgery.
ANC <1000 (Neutropenia): Evaluate and optimize — increased infection risk.
── PLATELETS ──
≥1,00,000: No contraindication.
75,000–1,00,000: Proceed with perioperative bleeding awareness and team planning.
50,000–75,000: Evaluate cause. Individualize decision.
<50,000: Correct before elective major surgery.
PLATELETS ≥1,00,000/MCL: ADEQUATE PLATELET COUNT. NO ACTIVE CONTRAINDICATION FOR PLANNED SURGERY FROM A COAGULATION STANDPOINT.
PLATELETS 75,000–1,00,000/MCL: MILD THROMBOCYTOPENIA NOTED. PROCEED WITH EXTRA PERIOPERATIVE BLEEDING AWARENESS. SURGICAL AND ANESTHESIA TEAMS SHOULD PLAN COAGULATION MANAGEMENT ACCORDINGLY.
PLATELETS 50,000–75,000/MCL: MODERATE THROMBOCYTOPENIA NOTED. EVALUATE UNDERLYING CAUSE. INDIVIDUALIZE THE SURGICAL DECISION BASED ON THE BLEEDING RISK OF THE SPECIFIC PROCEDURE.
── STANDARD CLEAR LINE ──
Patient evaluated medically. No active medical contraindication identified for planned elective surgery. Existing abnormalities assessed and optimization advised. Final surgical fitness to be considered jointly with operating surgeon and anesthesiologist.
── DO NOT CLEAR / DEFER ──
Active infection/sepsis · AKI · Decompensated heart failure · Uncontrolled arrhythmia · ACS · Severe symptomatic hypothyroidism · Acute hepatitis/liver failure · Severe anemia · Platelets <50,000