Perioperative Management of Sickle Cell Disease in Paediatric Cardiac Surgery

Author:

Bhatt K.12,Cherian S.13,Agarwal R.13,Jose S.14,Cherian K. M.15

Affiliation:

1. Departments of Cardiac Anaesthesiology and Critical Care Medicine, Frontier Lifeline, Chennai, India

2. Department of Cardiac Anaesthesiology.

3. Department of Cardiac Surgery.

4. Department of Perfusion Technology.

5. Chairman and CEO, Chief Cardiac Surgeon, Frontier Lifeline.

Abstract

In sickle cell disease, cardiopulmonary bypass may induce red cell sickling. Partial exchange transfusion reduces the circulating haemoglobin S level. We report the management of a child with sickle cell disease who required surgical closure of a ventricular septal defect. Preoperative exchange transfusion of 50% of the total blood volume was performed with fresh packed red cells over three days. Further exchange transfusion was performed as cardiopulmonary bypass commenced. The haemoglobin S level was reduced from 76% to 37%. The blood removed from the patient during the exchanges was processed allowing storage and re-infusion of the patient's plasma and platelets. Combined preoperative and intraoperative exchange transfusions, instead of a single stage 50% volume exchange, was effective and potentially avoids larger haemodynamic effects. Cardiopulmonary bypass was conducted at normothermia and cold cardioplegia was avoided (fibrillatory arrest was used during the surgical repair).

Publisher

SAGE Publications

Subject

Anesthesiology and Pain Medicine,Critical Care and Intensive Care Medicine

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