Anaesthesia in Hematological Disorders:Anemia,Sickle cell disease

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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Dr Sunita Goel
Lecturer in Anaesthesiology
BJ Wadia Children's Hospital

Hematological disorders :

Anemia: Children requiring surgery may be anemic. Remember that Hb level, normally 18-20g/dl at birth falls to 10-11g/dl by 3 months and thereafter climbs gradually to 14-16g/dl at 6 years of age.

In patients with anemia

O2 transport to the issues can be maintained by increased cardiac output or increased O2 extraction from blood.
Coronary sinus blood is normally desaturated, therefore O2 transport to the heart muscle can be maintained only by increased coronary blood flow.
Increased risk of cardiac arrest during anesthesia.
Patients with cardiac or serious respiratory disease require a higher Hb level than normal children.

If surgery cannot be delayed:

Transfuse the patient
If blood transfusion cannot be done
- Avoid excessive sedation
- Oxygenate well
- High O2 concentration
- Use ETT
- Use controlled ventilation
- Do not give CVS depressant drugs
- Extubate awake
- Give O2 during transport

Sickle cell disease: Presence of abnormal HbS. HbS forms a gel when deoxygenated, distorting the erythrocytes; these then occlude vessels, causing infarction. The disease is almost entirely confined to the black races and may become evident during infancy when HbS replaces fetal Hb.

Sickle cell trait (Mild): when HbS < 50%
Sickle cell disease (Severe form): When HbS > 75%

Next : Anaesthesia in Hematological Disorders(Contd.)

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