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ANEMIA- Anesthesia related complications

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What Is Anemia

  • Anemia is a decrease in the RBC count, hemoglobin and/or Hematocrit values resulting in a lower ability for the blood to carry oxygen to body tissues.

NORMAL RANGE ;

Female – 12-14 g/dl

Male – 14-16 g/dl

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Mild

9.0 – 10.9 gm/dl

Moderate

7.8 – 9.0 gm/dl

Severe

<7 gm/dl

Very severe

<4 gm/dl

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TYPES OF ANEMIA

  1. Iron deficiency anemia.�Megaloblastic anemia.�Pernicious anemia.- nutritional �Hemorrhagic anemia.�Aplastic anemia.�Hemolytic anemia-traumatic�Thalassemia
  2. Sickle cell anemia-genetic
  3. Aplastic anemia

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Causes Of Anemia

  • Anemia Caused by Iron Deficiency, folate , vitamin A�People with an iron deficiency may experience these symptoms: A hunger for strange substances such as paper, ice, or dirt (a condition called pica)�Upward curvature of the nails, referred to as koilonychias�Soreness of the mouth with cracks at the corners
  • Anemia Caused by Vitamin B12 Deficiency
  • CHRONIC DISEASES ; cancer, ckd, ulcerative cholitis, upper GI bleed
  • Certain medications like NSAIDs like aspirin , ibuprofen
  • Pregnancy
  • hemorroids

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People whose anemia is caused by a deficiency of Vitamin B12 may have these symptoms:

  • A tingling, “pins and needles” sensation in the hands or feet� Lost sense of touch� A wobbly gait and difficulty walking�Clumsiness and stiffness of the arms and legs� Dementia� Hallucinations, paranoia, and schizophrenia

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Clinical Features

  • Symptoms:
  • Tiredness
  • Easy fatiguability
  • Generalised muscular weakness
  • Lethargy
  • Headache.
  • In older patients, there may be symptoms of:
  • Cardiac failure
  • Angina pectoris
  • Intermittent claudication
  • Confusion
  • Visual disturbances

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  • Signs:
  • Pallor

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  • Cardiovascular system:
    • Tachycardia
    • Collapsing pulse
    • Cardiomegaly,
    • Midsystolic flow murmur
    • Dyspnoea on exertion
    • Elderly people congestive heart failure.

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  • Central nervous system: The older patients may develop symptoms such as
    • Attacks of faintness,
    • Giddiness
    • Headache
    • Tinnitus
    • Drowsiness
    • Numbness and
    • Tingling sensations of the hands and feet
  • Ocular: Retinal haemorrhages
  • Reproductive: Menstrual disturbances
  • Renal: Mild proteinuria
  • GIT: Anorexia, flatulence, nausea, constipation and weight loss

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Anesthesia related complications in anemia

  • Delayed Gastric Emptying- Poor autonomic system
  • Arrhythmias- Cardiac index instability
  • Hypotension- Due to Hypovolemia
  • Acute Kidney Injury- Reduced perfusion
  • Decreased Urine Output- reduced RBF and perfusion
  • Increased Respiratory Rate
  • Impaired Thermoregulation- Cause shivering postoperatively
  • Delayed Wound Healing

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  • Cardiac failure may occur if this is done rapidly in an effort to restore the hemoglobin level, on day evening before surgery
  • General anesthesia is often the preferred choice for patients with anemia
  • Severe anemia can lead to inadequate tissue oxygen delivery, which can cause tissue hypoxia, organ dysfunction, and organ damage.
  • Intra- and post-operative optimization of cardiac output and oxygenation helps to improve the patient's tolerance for anemia.
  • Displacement of the oxyhemoglobin dissociation curve to the right was present in anemia

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  • A reduced PAO2 may occur during the induction and maintenance of anesthesia
  • Oxyhemoglobin curve of blood from patients with a wide variety of anemias is displaced to the right
  • Elevated levels of cardiac output in several patients with sickle-cell anaemia
  • Desaturation of arterial blood in anemia
  • Anemia may be further aggravated in the postoperative period in patients with pre-operative anemia, peri-operative blood loss, poor nutritional intake post-operatively and frequent blood sampling for laboratory investigations

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Management of anesthesia

  • Delayed Gastric Emptying- manage with H-2 blockers
  • Arrhythmias- Cardiac index instability- ECG monitoring, anti arythemics
  • Hypotension- Due to Hypovolemia- manage with vasopressors and fluid management.
  • Acute Kidney Injury- Reduced perfusion- change in induction agents and muscle relaxants.
  • Decreased Urine Output- reduced RBF and perfusion, manage urine output with diuretics.
  • Increased Respiratory Rate- manage RR according to Etco2
  • Impaired Thermoregulation in neonate - Causes shivering after delivery, manage with warmer and warm IV fluids

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Anemia in pregnancy

  • Anemia in pregnancy is a common condition, typically characterized by a decrease in hemoglobin levels below 11 g/dL

Causes

  • Iron Deficiency
  • Folate Deficiency
  • Vitamin B12 Deficiency
  • Blood Loss
  • Electrolyte imbalance

Complications of Anaemia in Pregnancy

  • Fatigue and Weakness
  • Increased Risk of Infections
  • Postpartum Haemorrhage
  • Preeclampsia
  • Arythemia -SVT, AF

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Curative management

  • HB- <7.5 should be admitted
  • Diet
  • Antibiotic therapy
  • Blood transfusion
  • Iron therapy oral / parental

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Effects on foetus

  • Intrauterine hypoxia and growth retardation
  • Anemia for few months due to poor stores
  • Prematurity
  • LBW

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Management during labour

1st stage :

  • Oxygenation to increase oxygenation of maternal blood and prevent foetal hypoxia

3rd stage

  • Blood loss is managed by replacing FFP

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