Laboratory investigations should
include a complete blood count and coagulation studies, including bleeding
time, platelet count, and a blood smear (thrombocytopenia and
ultrastructural and functional studies showing macrothrombocytopathy).
Preoperative and intraoperative platelet transfusions are often required,
and packed red blood cells should be easily available. Evaluate renal
function with serum concentrations of electrolytes, creatinine, urea, and
urine analysis (proteinuria is common, and hematuria or red blood cell
casts suggest nephritis), and obtain a nephrology consult if necessary. If
renal function is severely altered (rare), check cardiac function with
electrocardiogram (arrhythmias as a result of electrolyte abnormalities),
and further testing such as echocardiography (with or without
dobutamine-stress test) may be necessary to detect decreased cardiac
function secondary to long-standing uremia.