Anesthetic management of Cesarean delivery in a patient with hypoplastic anemia and severe pre-eclampsia.
OBJECTIVE
To describe the anesthetic management of Cesarean delivery in a patient with hypoplastic anemia and severe pre-eclampsia.


METHODS
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.
Wong
Andrew Y C
AY
Department of Anaesthesiology F2, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China. wongyca@so-net.com.hk
Chan
Rebecca S N
RS
Irwin
Michael G
MG
D000328:Adult; D029502:Anemia, Hypoplastic, Congenital / Q000150:complications* / Q000628:therapy; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D001794:Blood Pressure / Q000187:drug effects; D002585:Cesarean Section; D005260:Female; D006801:Humans; D009543:Nifedipine / Q000627:therapeutic use; D017713:Platelet Transfusion; D011225:Pre-Eclampsia / Q000150:complications* / Q000188:drug therapy; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000628:therapy; D014665:Vasodilator Agents / Q000627:therapeutic use
D014665:Vasodilator Agents; D009543:Nifedipine