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ANAEMIA-ITS IMPORTANCE IN GENERAL SURGICAL PRACTICE

Understanding the significance of anaemia in surgeries, diagnostic methods, oxygen transport, compensatory mechanisms, synthetic oxygen carriers, erythropoietin role, blood transfusion, dangers of anaemia in intraoperative and postoperative periods.

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ANAEMIA-ITS IMPORTANCE IN GENERAL SURGICAL PRACTICE

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  1. ANAEMIA-ITS IMPORTANCE IN GENERAL SURGICAL PRACTICE Dr.R.Selvakumar

  2. ANAEMIA- Is it that important to discuss for an hour..? I.S.A-TNLI

  3. How much importance we give to anaemia? How do we diagnose anaemia? I.S.A-TNLI

  4. When we see 3G and 4G% Hb in the general population… Why do we have to worry? I.S.A-TNLI

  5. To answer these questions… …knowing some basics is necessary I.S.A-TNLI

  6. O2 is carried in blood in 2 forms: 1. Combined with Hb 2. Dissolved in plasma I.S.A-TNLI

  7. HOW MUCH O2 IS DISSOLVED IN PLASMA? • Quantity • Importance I.S.A-TNLI

  8. What do we achieve in giving O2 by mask? I.S.A-TNLI

  9. IMPORTANCE OF Hb • Amount of O2 carried by Hb • Reserve O2 • Amount of O2 needed for metabolism I.S.A-TNLI

  10. O2 CONTENT OF BLOOD {Hb X 1.32 X SaO2} +{ 0.003 X paO2} O2 FLUX: O2 content X cardiac output I.S.A-TNLI

  11. O2 CASCADE: Artblood 150mm Cap blood mitochondria air humidificaton 100mm End-exp gas Alv.gas 50mm I.S.A-TNLI

  12. In nutshell…. What we need is just 2mm of Hg of O2 at mitochondrial level…… I.S.A-TNLI

  13. What will happen if that is not provided? • Anaerobic metabolism • Scarcity of ATP I.S.A-TNLI

  14. If some stupid ATP is not provided why the cell has to die…? Importance of ATP pump I.S.A-TNLI

  15. COMPENSATORY MECHANISMS IN ANAEMIA: Can u increase the O2content of blood by manipulating the factors involved in the formula? {Hb X 1.32 X SaO2 } +{ 0.003 X paO2 } I.S.A-TNLI

  16. COMPENSATORY MECHANISM IN ANAEMIA; • Tachycardia • Cardiac strain • Vascular tone • Increased cardiac output • Associated hypoproteinaemia EASY TENDENCY FOR PULMONARY EDEMA I.S.A-TNLI

  17. HOW DO WE CORRECT ANAEMIA? • Oral and parentral preparations • Blood transfusion Is there any other way to tackle anemia? I.S.A-TNLI

  18. Can we manage without Hb? O2 content of 100ml of arterial blood= 20ml O2 content of 100 ml venous blood = 15 ml Tissues need just 5ml of O2 I.S.A-TNLI

  19. Impact of increasing atmospheric pressure I.S.A-TNLI

  20. Is there any alternate to Hb? SYNTHETIC O2 CARRIERS: 1.Perfluoro carbon-Fluosol-DA paO2 has to be above 300 mm of Hg 2. Perflurooctyl bromide: longer half life 3-4 times more O2 on the trials 3. Hb based O2 carriers outdated human RBCs, or bovine RBC increased affinity to O2 renal toxicity I.S.A-TNLI

  21. SYNTHETIC O2 CARRIERS: 4.Recombinant Hb from E.Coli 5. Recombinant erythropoietin 6. Haemopure: ultrapurified bovine RBC – gluteraldehyde polymerised no croosmatching or typing no transmission of infection increased BP and decreased CI approved in south africa I.S.A-TNLI

  22. ROLE OF ERYTHROPOIETIN IN TREATING ANEMIA • Recombinant erythropoietin ( rHuEPO) • 300 units/kg S/C daily for 5 days • Every other day for a minimum of 2 weeks • Improves the haematocrit • 36% compared to 31% in placebo I.S.A-TNLI

  23. BLOOD TRANSFUSION • Role of pre-op transfusion • How many bottles of blood to be given? I.S.A-TNLI

  24. PREOP BLOOD TRANSFUSION.. • Packed red cells • Risk of infection,circulatory overload. • 1 unit increases Hb by 1G% • ? Quality of the donated blood • ? Quality of storage • ? Simultaneous frusemide administration I.S.A-TNLI

  25. Is there a magic figure of Hb level before submitting the patient for an elective surgery? I.S.A-TNLI

  26. If oxygen saturation is good, can you take a patient for surgery with anaemia? I.S.A-TNLI

  27. If an ectopic rupture can be taken with a Hb of 3 or 4 g%, Why not a patient with 7 G%? I.S.A-TNLI

  28. DANGERS OF ANEMIA-INTRA OP PERIOD • May be masked • Increased O2 supply during GA compensates • Spinal- mild hypotension and vasodilatation • compensate I.S.A-TNLI

  29. DANGERS OF ANAEMIA – INTRAOP PERIOD Impact of anemia depends on existing organ function vascular status level of atherosclerosis cardiac status…etc I.S.A-TNLI

  30. DANGERS OF ANAEMIA – INTRAOP PERIOD Even during a normal course of a well conducted anesthesia and an uneventful Surgery, there may be brief periods of hypotension and hypoperfusion…. The impact of this is aggravated by anemia I.S.A-TNLI

  31. Word of caution: We measure the success of surgery only by looking at the absence of mortality not morbidity. I.S.A-TNLI

  32. DANGERS OF ANAEMIA- POSTOP PERIOD • Most dangerous period • All the supports are withdrawn • Persistent impact of anesthetic drugs and techniques • Surgical incision,pain all increase O2 requirement • Even shivering increases it by 200% All these factors resulting in a subtle hypoxaemia I.S.A-TNLI

  33. DANGERS OF ANEMIA- LATE POST OP PERIOD • Wound healing requires good O2 supply • Burst abdomen, wound dehescence, bowel anastamotic • leak,skin graft failure- all due to reduced O2supply • Associated hypoproteinaemia aggravates.. I.S.A-TNLI

  34. Summarising… 1.The tissues need just 2mm of Hg Oxygen 2. The O2 content of the blood can only be increased by maximising Hb. 3. Body tries to compensate for chronic anemia 4. Immediate preop blood transfusion may not help I.S.A-TNLI

  35. Summarising… 5.One unit of preop transfusion improves Hb by 1 g% 6. There is no fixed,magic figure of Hb before any surgery 7. Anaemia may not kill a patient intra operatively. 8. The most dangerous period is the post op period I.S.A-TNLI

  36. CONCLUSION: DON’T TAKE ANEMIA LIGHTLY IT IS ASILENT KILLER. I.S.A-TNLI

  37. Dr.R.Selvakumar Assistant professor, Madurai Medical College,Madurai THANK YOU

  38. THANK YOU

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