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Anaemia

Created: 2/4/2004

 

Introduction

  • Hb level below that for normal limits which are:

            - Male 13-17 (g/dl)

            - Female 11-16 (g/dl)

Causes

  • Acute/chronic blood loss (hypochromic)

  • Lack of vitamin B12 or folate (megaloblastic)

  • Marrow failure (hypoplastic)

  • Increased haemolysis

  • Red blood cell abnormalities (spherocytosis/sickle cell/G-6-PD deficiency)

  • Mechanical trauma: burns or prosthetic heart valves

  • Sepsis, antibodies, uraemia, hypersplenism 

Problems

  • CaO2=1.34 x Hb x Sat + 0.03[PaO2] units ml/dl

  • Maintenance of O2 delivery depends upon increasing cardiac output

  • Hb is an important buffer for CO2- thus, acidosis is more likely

  • Right shift of oxy-Hb curve

  • Transfused blood has low levels of 2,3-DPG, and  therefore unloads O2 poorly

Management

  • Optimised O2 carriage pre-op (Hct >0.3, Hb >10 g/L)

  • Maintain O2 saturation

  • CVP and urine output monitoring and also arterial line

  • Consider pulmonary artery catheter to maintain high CI

  • Select a technique to preserve CO and O2 delivery. This may need a high FiO2. Avoid hyperventilation

  • Post-op: transfuse to 12 g/dl. Continued O2 therapy until stable

  • Consider ITU/HDU.


ArticleDate:20040402
SiteSection: Article
 
   
    
                                            
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