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Ch 32 Anaesthesia and Anaemia

Ch 32 Anaesthesia and Anaemia

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Published by: Shimels Tekola on Dec 30, 2012
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CHAPTER 32

ANAESTHESIA AND ANAEMIA

Outline: Causes of anaemia Important points about anaemia Technique for anaesthesia

167

Anaemia is only a sign of disease.INTRODUCTION Anaemia is a fall in the haemoglobin (Hb) concentration of the blood. It is not a complete diagnosis. It is a common clinical finding. This can result from: − Chronic blood loss − Poor diet − Poor absorption from gut − Increased demand. Decreased blood production i. as in pregnancy Macrocytic anaemia. The underlying cause must be found. The haemorrhage may be in the: Gastrointestinal tract accompanying: − Peptic ulcer − Cancer − Haemorrhoids − Parasites − Ulcerative colitis Respiratory tract from haemoptysis. Microcytic anaemia (Iron deficiency). lack of factors needed for Hb.e. as for example in tuberculosis. Urinary tract from haematuria. CAUSES OF ANAEMIA There are three: • Increased blood loss • Decreased blood production • Increased blood destruction Increased blood loss This may occur as a result of acute or chronic haemorrhage. This can result from: − Vitamin B12 deficiency − Folic acid deficiency − Dietary deficiency − Pregnancy − Gastric resection 168 .

Unless the patient is dehydrated. Infectious diseases e. Depression of bone marrow − Aplastic anaemia e. lead poisoning.g. If a patient is dehydrated the haemoglobin (Hb) may be artificially high. lack of thyroxine or adrenal hormone. thalassaemia and congenital spherocytosis. haemolytic streptococcus and malaria.g. If only whole blood is available a small dose of diuretic (frusemide 10 mg IV) given with each unit helps to prevent overload. Hb x 3). e.g. In some hospitals the haematocrit is the only available test for anaemia. 169 . Find and treat the cause. toxins − Lack of erythropoietin in chronic renal failure − Infiltration of marrow as in leukaemia and carcinoma − Disease of the marrow. haematocrit gives a rough idea of Hb (approx.g.Protein deficiency Hormone deficiency e. Drugs e. In the elderly patient whole blood may be dangerous because it can suddenly increase the blood volume.g. sulphonamides primaquine quinidine penicillin IMPORTANT POINTS ABOUT ANAEMIA • • • • Anaemia is not a diagnosis but a symptom of an underlying disease. myelofibrosis − Chronic sepsis and infection Increased blood destruction Abnormal red blood cells in conditions such as sickle cell disease.g. Antibodies to red blood cells due to mismatched transfusions (of incompatible blood) or Rh factor incompatibility (erythroblastosis foetalis). When blood transfusions are needed to treat anaemia whole blood is not ideal. Packed cells may be safer. Chemicals and poisons e. Medical conditions such as secondary carcinoma systemic lupus erythematosis and leukaemia.

A minimum of 8gm/dL should be aimed at. • Extubate only when the patient is making a strong ventilatory effort. • Oxygenate before induction. A relatively fit patient with chronic anaemia may cope with surgery with a Hb as low as 7gm/dL whereas a patient with cardiac disease who may have a reduced cardiac output would not. • Have a good IV line in progress before you start. The possibility of high output cardiac failure must be considered. massive intra-abdominal bleeding. • Use a high oxygen concentration. e. Pre-operative Transfusion. • Avoid excess pre-operative sedation. • Use small doses of drugs. • Keep the patient warm and warm IV fluids. The acceptable Hb level will depend on the type of surgery. 170 . • Give the patient oxygen in the post-operative period – up to 100% O2 if the patient is shivering. • Intubate and ventilate except for very short procedures. the patient’s general condition and the expected blood loss.g. 1 unit of blood raises Hb by about 1gm Iron IM raises Hb by 1gm in 1 week Oral iron raises Hb by 1gm in 1 month TECHNIQUE FOR ANAESTHESIA These patients have minimum oxygen reserve. In patients with Hb less than 5gm/dL operate only in emergencies where surgery is life saving. Use ketamine instead of thiopentone and inject slowly. Packed cells (if available) can be given 24 hours before surgery.• • • Anaemia and the surgical patient In elective surgery aim to have the preoperative Hb as close to 10 gm/dL as possible. • Avoid myocardial depressants. See the information on Sickle cell anaemia in Chapter 33. Watch for signs of overload. • Replace blood loss carefully with whole blood or packed cells. • Transfuse or treat to correct anaemia. Hypotension or hypoxia can cause cardiac arrest. Blood should be given as soon as it is available.

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