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Anesthetic management of Cesarean delivery in a patient with hypoplastic anemia and severe pre-eclampsia

[L’anesthésie pendant une césarienne chez une patiente qui présente une anémie hypoplasique et une prééclampsie sévère]

From the Department of Anaesthesiology, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.

Address correspondence to: Dr. Andrew Y. C. Wong, Department of Anaesthesiology F2, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China. Fax: 852-2855-3384; E-mail: wongyca{at}so-net.com.hk

Purpose: To describe the anesthetic management of Cesarean delivery in a patient with hypoplastic anemia and severe pre-eclampsia.

Clinical features: A 28-yr-old parturient with a history of thrombocytopenia was admitted with signs of pre-eclampsia (blood pressure of 140/90 mmHg, heavy proteinuria and moderate bilateral ankle edema) at 25 weeks of gestation. Laboratory studies revealed pancy-topenia (hemoglobin 6.4 g·dL^–1, white cell count 3.43 x 10⁹·L^–1, platelet count 20 x 10⁹·L^–1) and bone marrow biopsy showed hypoplastic anemia. As pre-eclampsia worsened, a Cesarean delivery was performed at 27 weeks with prophylactic platelet transfusion and meticulous blood pressure control. The procedure was uneventful, conducted under general anesthesia with an estimated blood loss of around 600 mL and a live female baby was delivered. Postoperatively her blood pressure and neurological symptoms improved but thrombocytopenia remained at discharge.

Conclusions: Hypoplastic anemia is rare in pregnancy but it poses an increased risk for both mother and fetus. The mother is at risk of life-threatening episodes of bleeding and infection and a multidisciplinary team approach (obstetrician, anesthesiologist, hematologist and pediatrician) is essential. An accurate assessment of the hematological condition should be made and abnormalities corrected before surgery. Regional anesthesia may not be possible in this circumstance.