Do the patient's labs—WBC (white blood cell count) 9.4 ×10⁹/L, RBC (red blood cell count) 5.40 ×10¹²/L, hemoglobin 16.6 g/dL, hematocrit 54.3%, platelet count 233 ×10⁹/L, MCV (mean corpuscular volume) 100.6 fL, MCH (mean corpuscular hemoglobin) 30.7 pg, MCHC (mean corpuscular hemoglobin concentration) 30.6 g/dL, RDW‑CV (red cell distribution width‑coefficient of variation) 14.8%, MPV (mean platelet volume) 11.4 fL, differential within normal limits—preclude surgery?

Preoperative Laboratory Assessment

These laboratory values do not preclude surgery. All critical parameters fall within acceptable ranges for proceeding with elective or urgent surgical intervention, though the elevated hematocrit warrants brief evaluation before proceeding. 1

Critical Hematologic Parameters for Surgical Clearance

Hemoglobin and Oxygen-Carrying Capacity

• Your hemoglobin of 16.6 g/dL is well above the threshold for surgery. The 2024 AHA/ACC guidelines and 2025 Association of Anaesthetists guidelines establish that surgery should not proceed when hemoglobin falls below 7-8 g/dL in most patients, or below 10 g/dL in those with cardiovascular disease or limited cardiopulmonary reserve. 1
• Your value is more than double the restrictive transfusion threshold, providing excellent oxygen-carrying capacity for the perioperative period. 1

Platelet Count

• Your platelet count of 233 × 10⁹/L is completely adequate for any surgical procedure. Guidelines consistently require platelet counts above 50,000/mm³ for most surgeries and above 50,000-100,000/mm³ for neurosurgery or procedures with high bleeding risk. 1
• Your count is more than four times the minimum threshold, providing normal hemostatic function. 1

White Blood Cell Count and Infection Risk

• Your WBC of 9.4 × 10⁹/L with normal differential is reassuring and does not suggest active infection. The absolute neutrophil count of 6.3 × 10⁹/L is normal, indicating adequate immune function for surgical wound healing. 2
• No signs of leukocytosis (which would be >11 × 10⁹/L) or leukopenia that would delay elective surgery. 2

The Elevated Hematocrit: Clinical Significance

Assessment Required Before Surgery

• Your hematocrit of 54.3% is mildly elevated but does not automatically preclude surgery. However, this requires brief evaluation to exclude conditions that could increase perioperative thrombotic risk. 3
• The elevated MCV (100.6 fL) suggests macrocytic red cells, which combined with elevated hematocrit could indicate: chronic hypoxemia from lung disease, smoking-related polycythemia, dehydration causing relative erythrocytosis, or early polycythemia vera. 3

Immediate Preoperative Steps

• Confirm adequate hydration status, as dehydration is the most common cause of borderline hematocrit elevation and is easily correctable with intravenous fluids. 3
• Assess for hyperviscosity symptoms including headache, visual disturbances, dizziness, or poor concentration—none of which would be present at this hematocrit level unless there is underlying polycythemia vera. 3
• Obtain focused history for: smoking (causes compensatory erythrocytosis), obstructive sleep apnea, chronic lung disease, testosterone use, or high-altitude residence. 3

When Phlebotomy Would Be Required (Not Your Case)

• Therapeutic phlebotomy before surgery is indicated ONLY when hemoglobin exceeds 20 g/dL AND hematocrit exceeds 65% with hyperviscosity symptoms, or in confirmed polycythemia vera requiring hematocrit maintenance below 45%. 3
• Your hematocrit of 54.3% does not meet criteria for preoperative phlebotomy. 3

Other Laboratory Findings

Red Cell Indices

• The elevated MCV (100.6 fL) and elevated RDW-SD (55.6 fL) suggest mild macrocytosis with increased red cell size variation, commonly seen with alcohol use, vitamin B12/folate deficiency, or chronic disease. 4, 5
• The slightly low MCHC (30.6 g/dL) is of minimal clinical significance and does not affect oxygen delivery. 4
• None of these findings preclude surgery, though they warrant outpatient hematologic evaluation after recovery. 2

Mean Platelet Volume

• Your MPV of 11.4 fL is normal, indicating normal platelet production and function. 2

Surgical Risk Stratification

For Low-Risk Surgery

• All parameters are acceptable without any additional testing or intervention. 1
• Proceed with surgery after confirming hydration status. 1

For Intermediate to High-Risk Surgery

• Ensure adequate hydration with intravenous fluids if the patient has been NPO, which may normalize the hematocrit if relative erythrocytosis is present. 3
• Consider checking serum erythropoietin level if hematocrit remains elevated after hydration and there is concern for polycythemia vera, though this would not delay urgent surgery. 3
• For cardiac surgery specifically, the 2025 Association of Anaesthetists guidelines accept hemoglobin levels in your range and recommend a transfusion threshold of 75 g/L (7.5 g/dL) intraoperatively. 1

Common Pitfalls to Avoid

• Do not perform preoperative phlebotomy based solely on elevated hematocrit of 54.3%. Aggressive phlebotomy depletes iron stores and paradoxically increases thrombotic risk. 3
• Do not delay surgery for extensive hematologic workup unless there are symptoms of hyperviscosity or concern for acute leukemia (which your normal differential excludes). 3
• Do not overlook dehydration as the most common and easily reversible cause of borderline hematocrit elevation in surgical patients who have been NPO. 3

Definitive Recommendation

Proceed with surgery after ensuring adequate hydration. Your laboratory values meet all guideline-based thresholds for safe surgical intervention. The mildly elevated hematocrit should prompt a focused assessment for secondary causes (smoking, sleep apnea, dehydration) but does not require delay of necessary surgery or preoperative phlebotomy. 1, 3