Document Detail

Anesthetic management of Cesarean delivery in a patient with hypoplastic anemia and severe pre-eclampsia.
MedLine Citation:
PMID:  15525619     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To describe the anesthetic management of Cesarean delivery in a patient with hypoplastic anemia and severe pre-eclampsia. CLINICAL FEATURES: A 28-yr-old parturient with a history of thrombocytopenia was admitted with signs of pre-eclampsia (blood pressure of 140/90 mmHg, heavy proteinuria and moderate bilateral ankle edema) at 25 weeks of gestation. Laboratory studies revealed pancy-topenia (hemoglobin 6.4 g.dL(-1), white cell count 3.43 x 10(9).L(-1), platelet count 20 x 10(9).L(-1)) and bone marrow biopsy showed hypoplastic anemia. As pre-eclampsia worsened, a Cesarean delivery was performed at 27 weeks with prophylactic platelet transfusion and meticulous blood pressure control. The procedure was uneventful, conducted under general anesthesia with an estimated blood loss of around 600 mL and a live female baby was delivered. Postoperatively her blood pressure and neurological symptoms improved but thrombocytopenia remained at discharge. CONCLUSIONS: Hypoplastic anemia is rare in pregnancy but it poses an increased risk for both mother and fetus. The mother is at risk of life-threatening episodes of bleeding and infection and a multidisciplinary team approach (obstetrician, anesthesiologist, hematologist and pediatrician) is essential. An accurate assessment of the hematological condition should be made and abnormalities corrected before surgery. Regional anesthesia may not be possible in this circumstance.
Andrew Y C Wong; Rebecca S N Chan; Michael G Irwin
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthésie     Volume:  51     ISSN:  0832-610X     ISO Abbreviation:  Can J Anaesth     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-11-04     Completed Date:  2005-03-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  923-7     Citation Subset:  IM    
Department of Anaesthesiology F2, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
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MeSH Terms
Anemia, Hypoplastic, Congenital / complications*,  therapy
Anesthesia, General*
Anesthesia, Obstetrical*
Blood Pressure / drug effects
Cesarean Section*
Nifedipine / therapeutic use
Platelet Transfusion
Pre-Eclampsia / complications*,  drug therapy
Pregnancy Complications, Hematologic* / therapy
Vasodilator Agents / therapeutic use
Reg. No./Substance:
0/Vasodilator Agents; 21829-25-4/Nifedipine

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