ANAEMIA-ITS IMPORTANCE IN GENERAL SURGICAL PRACTICE

ANAEMIA-ITS IMPORTANCE IN GENERALANAEMIA-ITS IMPORTANCE IN GENERALSURGICAL PRACTICESURGICAL PRACTICE

Dr.R.SelvakumarDr.R.Selvakumar

ANAEMIA-ANAEMIA-

Is it that important to discussIs it that important to discussfor an hour..?for an hour..?

I.S.A-TNLII.S.A-TNLI

How much importance we give to anaemia?How much importance we give to anaemia?

How do we diagnose anaemia?How do we diagnose anaemia?


When we see 3G and 4G% Hb When we see 3G and 4G% Hb in the general population…in the general population…

Why do we have to worry?Why do we have to worry?


To answer these questions…To answer these questions…

…knowing some basics is necessaryknowing some basics is necessary


OO22 is carried in blood in 2 forms: is carried in blood in 2 forms:

1. Combined with Hb1. Combined with Hb

2. Dissolved in plasma2. Dissolved in plasma


HOW MUCH OHOW MUCH O2 2 IS DISSOLVED IN PLASMA?IS DISSOLVED IN PLASMA?

• QuantityQuantity• ImportanceImportance


What do we achieve in What do we achieve in giving Ogiving O22 by mask? by mask?


IMPORTANCE OF HbIMPORTANCE OF Hb

• Amount of OAmount of O22 carried by Hb carried by Hb

• Reserve OReserve O22

• Amount of OAmount of O22 needed for metabolism needed for metabolism


OO22 CONTENT OF BLOOD CONTENT OF BLOOD

{{Hb X 1.32 X SaOHb X 1.32 X SaO22 }} + +{{ 0.003 X paO 0.003 X paO22 }}

OO22 FLUX: FLUX:

OO22 content X cardiac output content X cardiac output


OO22 CASCADE: CASCADE:

air

humidificaton

End-exp gas

Alv.gas

Artblood

Cap blood

mitochondria

150mm

100mm

50mm


In nutshell….In nutshell….

What we need is just 2mm of Hg of OWhat we need is just 2mm of Hg of O22

at mitochondrial level……at mitochondrial level……


What will happen if that is not provided?What will happen if that is not provided?

•Anaerobic metabolismAnaerobic metabolism

•Scarcity of ATPScarcity of ATP


If some stupid ATP is not providedIf some stupid ATP is not provided

why the cell has to die…?why the cell has to die…?

Importance of ATP pumpImportance of ATP pump


COMPENSATORY MECHANISMS IN ANAEMIA:COMPENSATORY MECHANISMS IN ANAEMIA:

Can u increase the OCan u increase the O22 content of blood by content of blood by

manipulating the factors involved in the formula?manipulating the factors involved in the formula?


{Hb X 1.32 X SaO2 } +{ 0.003 X paO2 }{Hb X 1.32 X SaO2 } +{ 0.003 X paO2 }

COMPENSATORY MECHANISM IN ANAEMIA;COMPENSATORY MECHANISM IN ANAEMIA;

•TachycardiaTachycardia

•Cardiac strainCardiac strain

•Vascular toneVascular tone

•Increased cardiac outputIncreased cardiac output

•Associated hypoproteinaemiaAssociated hypoproteinaemia

EASY TENDENCY FOR PULMONARY EDEMAEASY TENDENCY FOR PULMONARY EDEMA


HOW DO WE CORRECT ANAEMIA?HOW DO WE CORRECT ANAEMIA?

•Oral and parentral preparationsOral and parentral preparations

•Blood transfusionBlood transfusion

Is there any other way to tackle anemia?Is there any other way to tackle anemia?


Can we manage without Hb?Can we manage without Hb?

OO22 content of 100ml of arterial blood= 20ml content of 100ml of arterial blood= 20ml

OO22 content of 100 ml venous blood = 15 ml content of 100 ml venous blood = 15 ml

Tissues need just 5ml of OTissues need just 5ml of O22


Atm.Atm.

presspressFiOFiO22 pIOpIO22 paOpaO22 OO22

contentcontent

DissolvDissolved Oed O22

1atm1atm 0.210.21 150m150mmm

87mm87mm 18.7ml18.7ml 0.3ml0.3ml

11 11 713713 673673 21.221.2 1.71.7

22 11 14731473 12181218 23.123.1 3.73.7

33 11 22332233 18641864 25.125.1 5.65.6

Impact of increasing atmospheric pressureImpact of increasing atmospheric pressure


Is there any alternate to Hb?Is there any alternate to Hb?

SYNTHETIC OSYNTHETIC O22 CARRIERS: CARRIERS:

1.Perfluoro carbon-Fluosol-DAPerfluoro carbon-Fluosol-DApaOpaO22 has to be above 300 mm of Hg has to be above 300 mm of Hg

2. Perflurooctyl bromide:2. Perflurooctyl bromide:longer half lifelonger half life3-4 times more O3-4 times more O22

on the trialson the trials3. Hb based O3. Hb based O22 carriers carriers

outdated human RBCs, or bovine RBCoutdated human RBCs, or bovine RBCincreased affinity to Oincreased affinity to O22

renal toxicityrenal toxicity


SYNTHETIC OSYNTHETIC O22 CARRIERS: CARRIERS:

4.4. Recombinant Hb from E.ColiRecombinant Hb from E.Coli5. Recombinant erythropoietin5. Recombinant erythropoietin6. Haemopure:6. Haemopure:

ultrapurified bovine RBC – ultrapurified bovine RBC – gluteraldehyde polymerisedgluteraldehyde polymerisedno croosmatching or typingno croosmatching or typingno transmission of infectionno transmission of infectionincreased BP and decreased CIincreased BP and decreased CIapproved in south africaapproved in south africa


ROLE OF ERYTHROPOIETIN IN ROLE OF ERYTHROPOIETIN IN TREATING ANEMIATREATING ANEMIA

•Recombinant erythropoietin ( rHuEPO)Recombinant erythropoietin ( rHuEPO)

•300 units/kg S/C daily for 5 days300 units/kg S/C daily for 5 days

•Every other day for a minimum of 2 weeksEvery other day for a minimum of 2 weeks

•Improves the haematocritImproves the haematocrit

•36% compared to 31% in placebo36% compared to 31% in placebo


BLOOD TRANSFUSIONBLOOD TRANSFUSION

•Role of pre-op transfusionRole of pre-op transfusion

•How many bottles of blood to be given?How many bottles of blood to be given?


PREOP BLOOD TRANSFUSION..PREOP BLOOD TRANSFUSION..

•Packed red cellsPacked red cells•Risk of infection,circulatory overload.Risk of infection,circulatory overload.•1 unit increases Hb by 1G%1 unit increases Hb by 1G%•? Quality of the donated blood? Quality of the donated blood•? Quality of storage? Quality of storage•? Simultaneous frusemide administration? Simultaneous frusemide administration


Is there a magic figure of Hb level before Is there a magic figure of Hb level before submitting the patient for an elective surgery?submitting the patient for an elective surgery?


If oxygen saturation is good, can you take a If oxygen saturation is good, can you take a patient for surgery with anaemia?patient for surgery with anaemia?


If an ectopic rupture can be taken with a Hb If an ectopic rupture can be taken with a Hb of 3 or 4 g%, Why not a patient with 7 G%?of 3 or 4 g%, Why not a patient with 7 G%?


DANGERS OF ANEMIA-INTRA OP PERIODDANGERS OF ANEMIA-INTRA OP PERIOD

•May be maskedMay be masked

•Increased OIncreased O22 supply during GA compensates supply during GA compensates

•Spinal- mild hypotension and vasodilatation Spinal- mild hypotension and vasodilatation compensatecompensate


DANGERS OF ANAEMIA – INTRAOP PERIOD DANGERS OF ANAEMIA – INTRAOP PERIOD

Impact of anemia depends onImpact of anemia depends onexisting organ functionexisting organ functionvascular statusvascular statuslevel of atherosclerosislevel of atherosclerosiscardiac status…etccardiac status…etc


DANGERS OF ANAEMIA – INTRAOP PERIOD DANGERS OF ANAEMIA – INTRAOP PERIOD

Even during a normal course of a well Even during a normal course of a well conducted anesthesia and an uneventful conducted anesthesia and an uneventful Surgery, there may be brief periods of Surgery, there may be brief periods of hypotension and hypoperfusion….hypotension and hypoperfusion….

The impact of this is aggravatedThe impact of this is aggravated by anemiaby anemia


Word of caution:Word of caution:

We measure the success of surgery only by We measure the success of surgery only by looking at the absence of mortality not morbidity.looking at the absence of mortality not morbidity.


DANGERS OF ANAEMIA- POSTOP PERIODDANGERS OF ANAEMIA- POSTOP PERIOD

•Most dangerous periodMost dangerous period•All the supports are withdrawnAll the supports are withdrawn•Persistent impact of anesthetic drugs and techniquesPersistent impact of anesthetic drugs and techniques•Surgical incision,pain all increase OSurgical incision,pain all increase O22 requirement requirement•Even shivering increases it by 200%Even shivering increases it by 200%

All these factors resulting in a subtle hypoxaemiaAll these factors resulting in a subtle hypoxaemia


DANGERS OF ANEMIA- LATE POST OP PERIODDANGERS OF ANEMIA- LATE POST OP PERIOD

•Wound healing requires good OWound healing requires good O22 supply supply

•Burst abdomen, wound dehescence, bowel anastamoticBurst abdomen, wound dehescence, bowel anastamotic leak,skin graft failure- all due to reduced Oleak,skin graft failure- all due to reduced O22supplysupply

•Associated hypoproteinaemia aggravates..Associated hypoproteinaemia aggravates..


Summarising…Summarising…

1.The tissues need just 2mm of Hg OxygenThe tissues need just 2mm of Hg Oxygen

2. The O2. The O22 content of the blood can only be content of the blood can only be

increased by maximising Hb.increased by maximising Hb.

3. Body tries to compensate for chronic anemia3. Body tries to compensate for chronic anemia

4. Immediate preop blood transfusion may not help4. Immediate preop blood transfusion may not help


Summarising…Summarising…

5. One unit of preop transfusion improves Hb One unit of preop transfusion improves Hb by 1 g%by 1 g%

6. There is no fixed,magic figure of Hb 6. There is no fixed,magic figure of Hb before any surgerybefore any surgery

7. Anaemia may not kill a patient intra operatively.7. Anaemia may not kill a patient intra operatively.

8. The most dangerous period is the post op period8. The most dangerous period is the post op period


CONCLUSION:CONCLUSION:

DON’T TAKE ANEMIA LIGHTLYDON’T TAKE ANEMIA LIGHTLY

IT IS AIT IS A SILENT KILLER.SILENT KILLER.


Dr.R.SelvakumarDr.R.SelvakumarAssistant professor,Assistant professor,Madurai Medical College,MaduraiMadurai Medical College,Madurai THANK YOUTHANK YOU

THANK YOU

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ANAEMIA-ITS IMPORTANCE IN GENERAL SURGICAL PRACTICE