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Abnormal HB
Abnormal HB
Abnormal HB
Abnormal
hemoglobin
By Dr. Ehab
Khairy
Abnormal Hemoglobin
May be due to:
1- Abnormal concentrations
High or low concentrations
2- Abnormal Structures
Sickle cell disorders
3- Abnormal Synthesis
Thalassemias
4- Abnormal Hemoglobin function
Met hemoglobin
Abnormally low Hemoglobin
Concentration
• Iron deficiency
• Chronic disease
∀ β Thalassemia
∀ α Thalassemia
• Sickle cell
• A plastic anemia
• Autoimmune
• Folic acid deficiency
• Vit.B12 deficiency
• Distribution Of Anemia
Physiological compensatory
Mechanisms for Low Hemoglobin
Manifestations Of Sever
Nutritional Anemia
Iron deficiency anemia
• Respiratory distress
• Congestive heart failure
• Thrombocytopenia
• Neurologic abnormalities
Vitamin B 12 deficiency
anemia
1- Neuropathy
* Sensory : Bilateral symmetrical parasthesia
Loss of propioceptive and vibratory sensations
* Motor: Diminished deep tendon reflexes
and un steady gait
* Mental: Impaired memory and mental
depression
2- Thyroid disorders: associated with
pernicious anemia
Folic acid deficiency anemia
• Smooth tongue
• Hyper pigmentation
• Mental depression
• Peripheral edema
• Liver dysfunction
• With or without peripheral neuropathy
Optimization Of Deficiency
Anemia Before Elective Surgery
Iron Deficiency Anemia
# Human Erythropoietin
Vitamin B12 Deficiency Anemia
3- Adequate Monitoring
Polycythemia
Thrombosis
Anesthetic Goals
Reduction of Hb conc. < 15g/dl prior to
elective surgery by
1- Minimizing tissue anoxia and other
factors
enhancing erythropoietin production
It may be Precipitated by
Infection, hypoxia, systemic disease,
acidosis, dehydration, trauma, and
Folic acid deficiency
Splenic Sequestration Crisis
Characterized by
Sudden pooling of blood in the spleen
due to partial occlusion of its drainage
It can cause life threatening hypotension
in infants and young children…… Why?
Avoid 6H & 1S
Hypoxia Hypercarbia
Hypotension Hypovolemia
Hypothermia Hyperthermia
Stases
Intra Operative Monitorings
CVP is useful to monitor volume state
Supplemental oxygen
Pain Control
Pulmonary physiotherapy
Early ambulation
Thalassemia
Types Of Thalassemia
Alpha Thalassemia
• Normal αα/αα
• Silent carrier - α/αα
• Minor -α/-α
--/αα
• Hb H disease --/-α
• Barts hydrops fetalis --/--
Beta Thalassemia
• Normal β/β
• Minor β/β0
β/β+
• Intermedia β0/β+
• Major β0/β0
β+/β+
2- Excessive hemolysis
Met Hb Co Hb
Oxy Hb Deoxy Hb
Management Of Acquired
Methemoglobin
Mild Methemoglobinemia
Oxygen administration
No specific therapy
Methylene Blue
Mechanism :Transfers electron to methemoglobin
reducing it to normal
Dosage :1-2mg/kg iv over 3-5 minutes
Can be repeated at a dose of 1mg/kg after 30
minutes
Symptoms expected to diminish within 30-60
minutes
Cautions: Not effective in G6PD deficiency and
may cause hemolysis in these cases