Perioperative management of thalassemia intermedia patient posted for major spine surgery – A case report

Abstract

Thalassemia patients are known to have abnormal haemoglobin structure and function because of genetic suppression of chains in haemoglobin molecule. These tend to lead to abnormal coagulation pathway and can cause excessive bleeding in the intra operative period. Hence, thalassemia patients are difficult and often considered as high-risk patients. Vigilant monitoring, early diagnosis and prompt treatment plays a vital role in the management and improving patient outcomes. This case illustrates a successful T4-T8 laminectomy and excision of extradural lesion in a patient with Thalassemia intermedia, pointing out the pathophysiologic considerations and discussing the means to reduce the perioperative risk. There have only been a few reports in the literature for the same and hence this article is intended to provide an overview of the anaesthetic management for a patient with thalassemia, focussing specifically on the blood conservation strategy for major spine surgeries. The particularities described in this case report may help other anaesthesiologists choose the best strategy when facing challenging patients similar to the one described.