Sickle Cell disease

[militarymd]

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got a guy today for Total Knee Arthroplasty...Sickle cell disease.

HCT 25

last pain crisis a couple of years ago.

No blood available...

What's everyone's practice on this type of patient?

- go to or for case
- transfuse to 30 before case


and what's the evidence ?

we actually cancelled the case because he had too many antibodies and couldn't find any blood for him.

Our hematologist said that his hct is where he lives, and to just go to the OR.

 

[VentdependenT]

got a guy today for Total Knee Arthroplasty...Sickle cell disease.

HCT 25

last pain crisis a couple of years ago.

No blood available...

What's everyone's practice on this type of patient?

- go to or for case
- transfuse to 30 before case


and what's the evidence ?

we actually cancelled the case because he had too many antibodies and couldn't find any blood for him.

Our hematologist said that his hct is where he lives, and to just go to the OR.

HB SS? Ouch. Guy's lucky he lived long enough to get a new knee.

Anypoops, I'd transfuse him. 2 units PRBC. With more on hold for post op.

Have a discussion about tourniquet. Should be OK after the transfusion.

 

[jwk]

If the guy lives at 25, that in and of itself isn't a problem. The unavailability of blood would bother me, and since this is a totally elective procedure, I'd elect to wait until blood was available.

 

[urge]

I doubt the hematologist is aware of tourniquet times exceding 2 hours some times. I would probably do the same as you did, transfuse to htc higher than 30 and try to minimize t time.

 

[Gator05]

...and I wouldn't settle for "Oh, we sent a T&C". Could take days...

 

[militarymd]

oh the blood is going to take days....

bone doc is going to modify his tq times....normally less than 1 hour, but he's going to go on and off so, should be much less.






but what's the data and/or recommendations....remember, I've been out of touch for 3 years from the latest and greatest.....

The last that I'm aware of is that a randomized trial is in the planning stages....Vichensky??? (oakland) is the expert.


and that it is more the type of surgery (major vs minor) that dictates need to blood and or higher hct.


so what's the academics have to say about this.

 

[coprolalia]

got a guy today for Total Knee Arthroplasty...Sickle cell disease.

Ahem. In Huntsville, as you should know, it is actually called "sick as hell" disease.

-copro

 

[Sevo]

got a guy today for Total Knee Arthroplasty...Sickle cell disease.

HCT 25

last pain crisis a couple of years ago.

No blood available...

What's everyone's practice on this type of patient?

- go to or for case
- transfuse to 30 before case


and what's the evidence ?

we actually cancelled the case because he had too many antibodies and couldn't find any blood for him.

Our hematologist said that his hct is where he lives, and to just go to the OR.

Wait until blood becomes available then transfuse him to 30 during the case. He's going to ooze down post-op. He may live at 25 but it's going to be 21 or 19 in 24-48 hours.

 

[mdqueen]

This is a review article. It does reference some of the newer thinking on the vascular dysfunction in sickle cell (gladwin et al nih), and the anesthestic approaches. I did research with this group so any of his reviews as well as elliot vichinsky's (children's oakland sickle cell guru) and richard castro from howard/nih are good in terms of understanding more about sickle pathology. hope this helps...


http://www.ncbi.nlm.nih.gov/pubmed/...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum