Hernia Repair with Platelet Count of 146,000/μL is Safe to Proceed
A platelet count of 146,000/μL is within the normal range and poses no contraindication to hernia repair surgery—you can proceed safely without any special precautions or platelet transfusion. 1, 2
Understanding the Platelet Count
Normal platelet count ranges from 150,000-450,000/μL, making 146,000/μL only minimally below the lower limit of normal and clinically insignificant 1
Guidelines recommend platelet transfusion only when counts fall below 50,000/μL for major surgery, establishing a safety threshold far below this patient's level 3, 1, 2
The American Association of Blood Banks (AABB) specifically states that 50,000/μL or greater is safe for major nonneuraxial surgery, meaning this patient has nearly three times the minimum safe threshold 2
Surgical Safety Evidence
Multiple studies demonstrate excellent safety profiles for hernia repair even in patients with significantly lower platelet counts than 146,000/μL 4, 5
A large series of 407 laparoscopic hernia repairs showed mean blood loss of only 35 mL with acceptable complication rates, and these patients were not selected for normal platelet counts 5
Research specifically examining hernia repair after liver transplantation identified low platelet counts as a risk factor only when counts were substantially depressed post-transplant, not at near-normal levels like 146,000/μL 4
No Special Precautions Required
Do not order prophylactic platelet transfusion, as this is not indicated for counts above 50,000/μL and carries unnecessary risks including transfusion-related lung injury 1, 2
Standard surgical hemostasis techniques are entirely adequate at this platelet level 5
Both open and laparoscopic approaches to hernia repair are equally safe with this platelet count 6, 7, 5
Common Pitfalls to Avoid
Avoid unnecessary delay of surgery based on this minimally low platelet count—the clinical significance is negligible 1
Do not confuse this near-normal count with true thrombocytopenia requiring intervention (counts <50,000/μL) 3, 2
Remember that platelet count alone does not predict bleeding risk; platelet function is equally important, but at 146,000/μL even mild dysfunction would not increase surgical risk 3, 1
If the patient is on antiplatelet therapy (aspirin), continuation through surgery has been shown safe for hernia repair without increased bleeding complications 6, 7