HEMATOLOGICAL DISORDERS AND PREGNANCY

ASSOCIATED DISEASE
GROUP 5 ANESTHESIA AND CO EXISTING DISEASE
HEMATOLOGICAL DISORDERS

 Hematological disorders, also known as blood disorders, affect the blood and its components, such as blood cells,
hemoglobin, blood proteins, and the mechanism of blood clotting.
 These disorders can be broadly categorized into three main types: red blood cell disorders, white blood cell
disorders, and platelet disorders
MAJOR HEMATOLOGICAL DISORDERS

 Anemia: A condition characterized by a decrease in the number of red blood cells or a deficiency of hemoglobin,
leading to reduced oxygen-carrying capacity of the blood. Iron-deficiency anemia, vitamin B12 deficiency
anemia, and sickle cell anemia are examples.
 Hemophilia: A genetic disorder that impairs the body's ability to control blood clotting, leading to prolonged
bleeding.
 Thrombocytopenia: A condition characterized by a low platelet count, which can result in excessive bleeding.
 Leukemia: A group of cancers that affect the blood-forming tissues, leading to the overproduction of abnormal
white blood cells. There are different types of leukemia, including acute lymphoblastic leukemia (ALL), acute
myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), and chronic myeloid leukemia (CML).
 Lymphoma: A type of cancer that originates in the lymphatic system, affecting lymphocytes (a type of white
blood cell). Hodgkin lymphoma and non-Hodgkin lymphoma are two main types.
 Multiple Myeloma: A cancer that affects plasma cells, a type of white blood cell that produces antibodies.
CONT…..

 Polycythemia Vera: A disorder characterized by the overproduction of red blood cells, leading to an increased blood
volume and thickness.
 Sickle Cell Disease: A genetic disorder that causes red blood cells to become misshapen and break down, leading to
anemia and other complications.
 Aplastic Anemia: A condition in which the bone marrow fails to produce enough blood cells, including red blood cells,
white blood cells, and platelets.
 Hemochromatosis: A condition in which there is an excessive accumulation of iron in the body, which can lead to organ
damage.
 Idiopathic Thrombocytopenic Purpura (ITP): An autoimmune disorder in which the immune system destroys platelets,
leading to a low platelet count and increased risk of bleeding.
 Von Willebrand Disease: A bleeding disorder caused by a deficiency or dysfunction of von Willebrand factor, a protein
that helps blood to clot.
ANEMIA

 Anemia is a condition characterized by a decreased  Vitamin B12 Deficiency Anemia:

number of red blood cells or a deficiency of hemoglobin,  Cause: Insufficient absorption of vitamin B12, often due to
leading to reduced oxygen-carrying capacity of the blood. malabsorption or dietary deficiency.
 Types of Anemia:  Clinical Features: Fatigue, neurological symptoms.
 Iron-deficiency Anemia:  Management: Vitamin B12 supplementation, addressing

 Cause: Inadequate iron intake or absorption.

the underlying cause.
 Sickle Cell Anemia:
 Clinical Features: Fatigue, pallor, weakness.
 Cause: Genetic mutation affecting hemoglobin structure.
 Management: Iron supplementation, correction of
underlying cause.  Clinical Features: Pain crises, anemia, organ damage.
 Management: Pain control, hydration, blood transfusions,
hydroxyurea, and sometimes bone marrow transplantation.
MANAGEMENT

 PREOPERATIVE ASSESSMENT:  Fluid Management:

 Identify the Underlying Cause:  Ensure adequate hydration to optimize blood volume and
perfusion.
 Conduct a thorough preoperative assessment to identify the
cause and severity of anemia.  POSTOPERATIVE CARE:
 Laboratory Evaluation:  Pain Management:
 Assess hemoglobin levels, hematocrit, and other relevant blood  Adequate pain control is crucial, especially for conditions like
parameters. sickle cell anemia, to prevent pain crises.
 INTRAOPERATIVE CONSIDERATIONS:  Monitoring for Complications:
 Monitoring:  Vigilant monitoring for postoperative complications such as
infection or delayed wound healing.
 Continuous monitoring of oxygen saturation (pulse oximetry),
hemodynamic parameters, and end-tidal CO2.  Addressing Underlying Causes:
 Blood Transfusion:  Postoperatively, continue to address and manage the underlying
causes of anemia.
 Depending on the severity of anemia, blood transfusion may be
considered to optimize oxygen-carrying capacity.
CONT….

 Special Considerations for Sickle Cell Anemia:

 Avoidance of Hypoxia:
 Prevent hypoxia as it can trigger sickle cell crises. Use supplemental oxygen as needed.

 Hydration:
 Maintain euvolemia to prevent sickling of red blood cells.

 Temperature Control:
 Avoid hypothermia, as it can trigger vaso-occlusive crises.
HEMOPHILIA:

 Hemophilia is a genetic disorder characterized by a bleeding after minor injuries or surgeries.

deficiency or dysfunction of clotting factors, leading to  Spontaneous Bleeding:
impaired blood clotting and prolonged bleeding.
 Spontaneous bleeding into joints and muscles can occur,
 TYPES OF HEMOPHILIA: leading to pain and potential long-term joint damage.
 Hemophilia A:
 Deficiency of clotting factor VIII.

 Hemophilia B:
 Deficiency of clotting factor IX.

 CLINICAL FEATURES:
 Prolonged Bleeding:
 Individuals with hemophilia may experience prolonged
 ANESTHESIA MANAGEMENT

 PREOPERATIVE ASSESSMENT:  Careful Hemostasis:

 Identify the Type and Severity:  Ensure meticulous hemostasis during surgery to minimize bleeding.
 Determine whether the patient has hemophilia A or B and assess the severity of  Avoid NSAIDs:
the deficiency.  Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided as they can
 Obtain Coagulation Profile: further increase the risk of bleeding.
 Measure clotting factor levels (factor VIII for hemophilia A, factor IX for  POSTOPERATIVE CARE:
hemophilia B) to assess the degree of deficiency.
 Continued Factor Replacement:
 INTRAOPERATIVE CONSIDERATIONS:  Depending on the type and severity of hemophilia, continue factor replacement
 Close Collaboration: therapy postoperatively to maintain adequate clotting factor levels.
 Collaborate with hematologists and other specialists to optimize clotting factor  Monitoring for Complications:
levels before surgery.  Monitor for signs of bleeding and complications, especially in the early
 Factor Replacement Therapy: postoperative period.
 Administer factor replacement therapy to raise clotting factor levels before  Pain Management:
surgery, depending on the patient's baseline levels and the type of surgery.  Use alternative pain management strategies that do not increase the risk of
 Avoidance of Trauma: bleeding.
 Minimize trauma during intubation, invasive procedures, and surgery to reduce
the risk of bleeding.
THROMBOCYTOPENIA

 Thrombocytopenia is a condition in which the platelet count in the blood is lower than normal, leading to a decreased ability to form
blood clots.
 CAUSES:
 Decreased Production of Platelets:
 Bone marrow disorders, chemotherapy, certain medications.
 Increased Destruction of Platelets:
 Immune thrombocytopenic purpura (ITP), medications, infections.
 Sequestration or Dilution:
 Splenic sequestration, massive transfusion.
 CLINICAL FEATURES:
 Prolonged Bleeding:
 Increased susceptibility to bleeding, especially after trauma or surgery.
 Petechiae and Ecchymoses:
 Small red or purple spots on the skin.
 ANESTHESIA MANAGMENT

 PREOPERATIVE ASSESSMENT: procedures to reduce the risk of bleeding.

 Identify the Cause and Severity:  Topical Hemostatic Agents:
 Determine the underlying cause of thrombocytopenia and assess the severity of  Use topical hemostatic agents to help control bleeding.
the condition.  POSTOPERATIVE CARE:
 Complete Blood Count (CBC):  Continued Monitoring:
 Obtain a CBC to assess platelet count, along with other relevant coagulation  Monitor for signs of bleeding in the early postoperative period.
parameters.
 Platelet Transfusion as Needed:
 INTRAOPERATIVE CONSIDERATIONS:
 If necessary, continue or initiate platelet transfusion postoperatively based on
 Communication with Hematology: clinical judgment and platelet count.
 Collaborate with hematologists to understand the cause and severity of  Optimize Pain Management:
thrombocytopenia.
 Choose pain management strategies that minimize the risk of bleeding
 Platelet Transfusion: complications.
 In some cases, platelet transfusion may be considered to raise platelet counts  Avoid NSAIDs:
before surgery, particularly if the count is critically low or the planned procedure
carries a significant bleeding risk.  Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided due to their
potential to affect platelet function.
 Minimize Trauma:
 Carefully handle tissues and minimize trauma during intubation and surgical
LEUKEMIA

 Leukemia is a cancer of the blood and bone marrow,  Chronic Myeloid Leukemia (CML):
characterized by the overproduction of abnormal white  Involves the gradual overproduction of abnormal myeloid
blood cells. cells.
 TYPES:  CLINICAL FEATURES:
 Acute Lymphoblastic Leukemia (ALL):  Bone Marrow Suppression:
 Involves rapid overproduction of immature lymphocytes.  Leads to anemia, thrombocytopenia, and neutropenia.
 Acute Myeloid Leukemia (AML):  Infection Susceptibility:
 Involves rapid overproduction of abnormal myeloid cells.  Due to compromised immune function.
 Chronic Lymphocytic Leukemia (CLL):  Bleeding Tendency:
 Involves the gradual overproduction of abnormal  Resulting from decreased platelet production.
lymphocytes.
 ANESTHESIA MANAGEMENT

 PREOPERATIVE ASSESSMENT:  Continuous monitoring of vital signs, oxygen saturation, and end-tidal CO2.
 Evaluate Disease Status:  Infection Prevention:
 Assess the type of leukemia, disease stage, and response to treatment.  Implement infection control measures to prevent perioperative infections.
 Hematologic Parameters:  POSTOPERATIVE CARE:
 Review hematologic parameters, including complete blood count (CBC) and  Intensive Monitoring:
coagulation studies.  Close postoperative monitoring, especially in the immediate recovery period.
 Assess Organ Function:  Pain Management:
 Evaluate organ function, particularly the heart, lungs, and liver.  Optimize pain management strategies, considering the potential for
 INTRAOPERATIVE CONSIDERATIONS: compromised organ function and the need to avoid certain medications.
 Collaboration with Hematology/Oncology:  Prevent Infections:
 Collaborate with hematologists/oncologists for a thorough understanding of  Implement measures to prevent postoperative infections.
the patient's disease status and treatment plan.  Coordinate with Hematology/Oncology:
 Blood Product Availability:  Collaborate with the patient's hematologist/oncologist for postoperative
 Ensure the availability of blood products given the potential for bleeding and management and ongoing care.
anemia.
 Careful Monitoring:
MULTIPLE MYELOMA:

 Multiple myeloma is a malignancy involving plasma cells, leading to the overproduction of abnormal antibodies
and other complications.
 CLINICAL FEATURES:
 Bone Lesions:
 Destruction of bone tissue can lead to bone pain and fractures.

 Anemia:
 Impaired production of normal blood cells can result in anemia.

 Renal Dysfunction:
 Abnormal plasma cells may cause damage to the kidneys.

 Hypercalcemia:
 Release of calcium from damaged bones can lead to elevated blood calcium levels
 ANESTHESIA MANAGMENT

 Preoperative Assessment:  Avoid nephrotoxic agents to protect renal function.

 Evaluate Disease Status:  Monitor for Hypercalcemia:
 Assess the stage and severity of multiple myeloma, including its impact on  Be vigilant for signs of hypercalcemia, such as altered mental status or
bones, kidneys, and other organs. cardiac arrhythmias.
 Renal Function:  Postoperative Care:
 Assess renal function, as kidney involvement is common in multiple  Pain Management:
myeloma.  Optimize pain management strategies, considering the potential for bone pain
 Cardiac Evaluation: and the need to avoid certain medications.
 Evaluate cardiac function, particularly in the context of potential fluid shifts.  Renal Monitoring:
 Intraoperative Considerations:  Continue monitoring renal function postoperatively, especially if the patient
has pre-existing kidney dysfunction.
 Bone Protection:
 Coordinate with Hematology/Oncology:
 Carefully position and pad the patient to minimize the risk of fractures, given
the susceptibility of bones to damage.  Collaborate with the patient's hematologist/oncologist for postoperative
management and ongoing care.
 Fluid Management:
 Thromboprophylaxis:
 Pay close attention to fluid management, especially in the presence of renal
dysfunction and potential for hypercalcemia.  Consider thromboprophylaxis, as multiple myeloma is associated with an
increased risk of thromboembolic events.
 Avoid Nephrotoxic Agents:
POLYCYTHEMIA VERA:

 Polycythemia vera is a myeloproliferative disorder characterized by the excessive production of red blood cells,
often leading to increased blood viscosity.
 CLINICAL FEATURES:
 Increased Blood Volume:
 Elevated levels of red blood cells lead to increased blood volume.

 Thrombotic Complications:
 Higher viscosity increases the risk of thrombotic events, such as stroke or myocardial infarction.

 Hemorrhagic Complications:
 Increased blood viscosity can impair platelet function, leading to bleeding complications.

 Splenomegaly:
 The spleen may become enlarged due to increased blood cell production.
ANESTHESIA MANAGEMENT

 Preoperative Assessment:  Monitoring:

 Evaluate Disease Status:  Continuous monitoring of vital signs, including careful attention to
oxygen saturation and end-tidal CO2.
 Assess the severity and complications of polycythemia vera, including the
presence of thrombotic events.  Postoperative Care:
 Cardiovascular Assessment:  Thromboprophylaxis Continuation:
 Evaluate cardiovascular status, considering the increased blood volume  Continue thromboprophylaxis postoperatively, especially in high-risk
and potential for thrombosis. situations.
 Intraoperative Considerations:  Monitoring for Complications:
 Fluid Management:  Vigilantly monitor for signs of thrombotic or hemorrhagic complications.
 Carefully manage fluid balance to avoid excessive intravascular volume  Pain Management:
expansion.  Optimize pain management while considering the patient's cardiovascular
 Thromboprophylaxis: and hematological status.
 Consider thromboprophylaxis to reduce the risk of perioperative  Coordination with Hematology:
thrombotic events.  Collaborate with hematologists for postoperative management and
 Avoid Hyperviscosity: ongoing care.
 Minimize factors that may exacerbate hyperviscosity, such as hypothermia
or dehydration.
HEMOCHROMATOSIS:

 Hemochromatosis is a hereditary disorder characterized by excessive iron absorption, leading to iron overload and
potential organ damage.
 CLINICAL FEATURES:
 Iron Overload:
 Accumulation of iron in various tissues and organs.

 Organ Damage:
 Can lead to complications such as liver cirrhosis, cardiomyopathy, and diabetes.
ANESTHESIA MANAGEMENT

 PREOPERATIVE ASSESSMENT:  Coagulation Status:

 Evaluate Organ Function:  Assess and monitor coagulation status, as hemochromatosis can be
associated with alterations in clotting factors.
 Assess the status of organs affected by iron overload, particularly the liver,
heart, and pancreas.  POSTOPERATIVE CARE:
 Cardiovascular Assessment:  Monitoring for Organ Dysfunction:
 Evaluate cardiovascular function, as iron deposition in the heart can lead  Vigilantly monitor for signs of organ dysfunction, particularly in the
to cardiomyopathy. immediate postoperative period.
 INTRAOPERATIVE CONSIDERATIONS:  Pain Management:
 Fluid Management:  Optimize pain management while considering the potential impact on
organ function and the need to avoid certain medications.
 Carefully manage fluid balance to avoid exacerbating potential heart and
liver dysfunction.  Hemoglobin and Iron Monitoring:
 Monitoring:  Monitor hemoglobin levels and iron status postoperatively.
 Continuous monitoring of vital signs, including attention to cardiac  Coordination with Hematology:
function and signs of organ dysfunction.  Collaborate with hematologists or other specialists familiar with the
 Avoid Nephrotoxic Agents: patient's hemochromatosis for ongoing care.
 Since iron deposition in the kidneys can occur, avoid nephrotoxic agents
to protect renal function.
PREGNANCY-RELATED DISORDERS
PREGNANCY-RELATED DISORDERS

 Pregnancy-related disorders encompass a range of conditions that can affect both the mother and the developing
fetus during pregnancy.
 Proper anesthesia management in these situations is crucial to ensure the well-being of both the pregnant patient
and the unborn child.
 Here are descriptions of some major pregnancy-related disorders and their general management in anesthesia:
GESTATIONAL DIABETES MELLITUS (GDM):

 GDM is a type of diabetes that develops during pregnancy.

 Anesthesia Management:
 Preoperative Assessment: Evaluate glycemic control and screen for other complications.
 Intraoperative Monitoring: Monitor blood glucose levels closely during surgery.
 Management of Diabetes Medications: Adjust insulin dosage as needed to maintain blood glucose within target
ranges.
 Postoperative Monitoring: Continue blood glucose monitoring postoperatively.
PREECLAMPSIA:

 Preeclampsia is a pregnancy-related condition characterized by high blood pressure and damage to other organ
systems, usually the liver and kidneys.
 Anesthesia Management:
 Preoperative Assessment: Evaluate the severity of preeclampsia and its impact on organ function.
 Blood Pressure Control: Maintain blood pressure within a safe range to prevent further complications.
 Fluid Management: Carefully manage fluid balance to avoid exacerbating hypertension and edema.
 Magnesium Sulfate Administration: Administer magnesium sulfate if indicated for seizure prophylaxis.
 Postoperative Monitoring: Continue close monitoring postoperatively for potential complications.
PLACENTA PREVIA:

 Placenta previa occurs when the placenta partially or completely covers the cervix.
 Anesthesia Management:
 Preoperative Assessment: Identify the type and severity of placenta previa.
 Avoid Vaginal Examinations: Minimize vaginal examinations to prevent bleeding.
 Blood Product Availability: Ensure the availability of blood products in case of hemorrhage.
 Delivery Planning: Collaborate with obstetricians to plan for a safe delivery after careful consideration of the
placenta's location.
PLACENTAL ABRUPTION:

 Placental abruption is the separation of the placenta from the uterine wall before delivery.
 Anesthesia Management:
 Preoperative Assessment: Evaluate the extent and severity of placental abruption.
 Blood Product Availability: Prepare for potential hemorrhage by ensuring blood products are available.
 Emergency Delivery Planning: Be prepared for an emergency cesarean section if needed for fetal distress or
maternal hemorrhage.
PRETERM LABOR:

 Preterm labor involves contractions and cervical changes that occur before 37 weeks of gestation.
 Anesthesia Management:
 Tocolytic Therapy: If indicated, administer tocolytic medications to inhibit contractions.
 Corticosteroid Administration: Administer corticosteroids to enhance fetal lung maturity if preterm delivery is
imminent.
 Fetal Monitoring: Continuously monitor fetal well-being during surgery, considering the potential impact on the
premature fetus.
HYPEREMESIS GRAVIDARUM:

 Hyperemesis gravidarum is severe nausea and vomiting during pregnancy, leading to dehydration and weight loss.
 Anesthesia Management:
 Preoperative Fluid Resuscitation: Correct dehydration with intravenous fluids before surgery.
 Avoidance of Nausea-Inducing Agents: Choose anesthesia medications that minimize nausea and vomiting.
 Postoperative Antiemetic Therapy: Administer antiemetic medications postoperatively to prevent or manage
nausea.
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