Aliya Ahmed, Abdul Monem.
Perioperative anesthetic management of a patient with relapsed Aplastic Anemia.
J Pak Med Assoc Jan ;55(6):257-9.

A 35 year old woman, known case of idiopathic aplastic anaemia since 2000, presented with a history of menorrhagia for several months. The patient had received Antilymphocyte Globulin and remained in remission until September 2001, but then relapsed. The haematologist`s advice was to perform surgery only as the last resort. Her menorrhagia did not respond to conservative management and a total abdominal hysterectomy was planned. Her haemoglobin was 6.8g/dl, platelet count was 13x109/1 and white cell count was 2.8x109/l. Her preoperative optimization was done in collaboration with the haematology department and the blood bank. She was transfused packed red cells and her haemoglobin was raised to 9.5g/dl and white cell count to 3.2x109/1. The surgery was uneventful and lasted about ninety minutes. Surgical blood loss was approximately 500ml, which was replaced with packed red cells. Six units of platelets were transfused intraoperatively. The patient remained stable throughout the procedure with adequate urine output. Extubation was atraumatic and the patient made a good recovery. Postoperative pain relief was provided with pethidine using patient controlled intravenous analgesia. Regular blood counts were performed perioperatively (Table). Postoperative course was uneventful and the patient was discharged home on the fifth postoperative day.

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