Yusuf ÜNAL, Zerrin ÖZKÖSE, Melis GÖKÇE, Ayşe YARICI, Berrin IŞIK

Talasemili gebedede splenektomi ve sezaryen için aralıklı talasemili gebedede splenektomi ve sezaryen için aralıklı

Globin zincir defektinden kaynaklanan talasemide, eritrosit rijiditesinin artması ve membran stabilitesinin azalması splenik sekestrasyona neden olmaktadır. Eritrosit ömrünü kısaltan splenik sekestrasyonu önlemede erken yaşta splenektomi uygulanmaktadır. Talaseminin klinik seyrinde gözlenen sorunlar yanında talasemili gebede gelişen splenik laserasyon anne ve bebek morbidite ve mortalitesinde artışa yol açabilir. Yazımızda 28 yaşında, talasemili olgunun gebeliğinin 23. haftasında genel anestezi altında acil splenektomi ve 39. haftasında epidural anestezi ile sezaryen uygulanan hastada yaklaşımımızı ve bebeğin prognozunu sunarak literatür bilgileri ışığında tartışmayı hedefledik.

Intermittent anesthesia for splenectomy and caesarian sectio in pregnant patient with thalassemia (case report)

Globin chain defect which is responsible for thalassemia causes splenic sequestration by increasing the erythrocyte rigidity and decreasing the membrane stability. In order to avoid the splenic sequestration which abbreviates erythrocyte life span, splenectomy is necessary in the early years of life. Some clinical abnormalities as well as splenic laceration may be the cause of maternal and fetal mortality and morbidity in thalassemia disease. We report a case of a pregnant patient with thalassemia who underwent an urgent splenectomy under general anaesthesia at 23. gestational week and caesarean section under epidural anaesthesia at 38. gestational week. We aim to submit prognosis of the newborn and discuss the light of the literature.

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1- Orr D. Difficult intubation: A hazard in thalassaemia;(case report) Br J Anaesth 1967:39;585-6
2- T.C. Sağlık Bakanlığı Hemoglobinopati Kontrol Programı Mevzuatı, Genelge 2005/62. Ankara.
3- Schrier SL, Angelucci E. New strategies in the treatment of the thalassemias. Annu Rev Med. 2005;56:157–71.
4- Poole JH.Thalassemia and Pregnancy. J Perinat Neonatal Nurs 2003:17;196–208.
5- Cohen AR, Galanello R, Pennell DJ, Cunningham MJ, Vichinsky E. Thalassemia. Hematology 2004;14–34.
6- Montalembert M. Transfusion in patients with hemoglobinopathies. Transfus Clin Biol. 2000;7(6):553–8.
7- Mak PH, Ooi RG. Submental intubation in a patient with beta-thalassaemia major undergoing elective maxillary and mandibular osteotomies. Br J Anaesth. 2002;88:288–91.
8- Moratelli S, DeSanctis V, Gemmati D, et al. Thrombotic risk in thalassemic patients. J Pediatr Endocrinol Metab. 1998;11: 915–21.
9- Jenkins TM, Mackey SF, Benzoni EM, Tolosa JE, Sciscione AC. Non-obstetric surgery during gestation:Risk factors for lower birthweight. Aust NZJ Obstet Gynaecol 2003;43:27–31.
10- Lyons G, Akerman N. Problems with general anaesthesia for Caesarean section. Minerva Anestesiol. 2005;71:27–38.
11- Kuczkowski KM. Nonobstetric surgery during pregnancy: what are the risks of anesthesia? Obstet Gynecol Surv. 2004;59:52–6.
12- Miller R: Miller Anesthesia for Obstetrics, 6th ed. Churchill Livingstone, 2005 p:2336, Chapter 58.