Phenazopyridine-induced hemolytic anemia

An elderly inan was seen with hemolytic anemia due to the urinary tract analgesic, phenazopyridine hydrochloride. The inechanisins underlying this toxic reaction are presented. Cautious use of this drug in elderly patients and in those with renal insufficiency is emphasized.     

Autoimmune hemolytic anemia associated with seminoma

The first case report of seminoma of the testis associated with autoimmune hemolytic anemia is presented. Additional unusual manifestations of the seminoma in this patient included a diffuse osteosclerosis due to metastatic bony involvement and prompt abatement of the hemolysis following splenectomy. The association of epithelial neoplasms with autoimmune hemolytic anemia is discussed.     

Laparoscopic cholecystectomy in children with chronic hemolytic anemia

Background The aim of this study was to evaluate whether the outcome in children with chronic hemolytic anemia (CHA) and cholelithiasis undergoing laparoscopic cholecystectomy (LC) is related to the operation timing. Methods From June 1995 to December 2004, 46 children with CHA were referred to our division of surgery for cholelithiasis. All 46 children were asymptomatic at the time of the first visit, and an elective LC was proposed to all of them before the onset of symptoms. The operation was accepted in the period of study by 24 children and refused by 22. The patients were divided into three groups (group A, asymptomatic; group B, symptomatic; and group C, emergency admitted) depending on clinical presentation and operation timing, and the respective outcomes were compared. Results Elective LC in asymptomatic children (group A) is safe with no major complications reported. In children who refused surgery (groups B and C), we observed four sickle cell crises, four acute cholecystitis, and two choledocholithiasis, and all these complications were related to waiting. Two sickle cell crises occurred in symptomatic children waiting for surgery during biliary colic. The risk of emergency admission in children with cholelithiasis and CHA awaiting surgery was found to be high: 28% of the children admitted in emergency after a mean of 32 months (range, 22–36). Morbidity rate and postoperative stay increased when children with hemoglobinopathies underwent emergency LC. Conclusions Elective LC should be the gold standard in children with CHA and asymptomatic cholelithiasis in order to prevent the potential complications of cholecystitis and choledocholithiasis, which lead to major risks, discomfort, and longer hospital stay.     

Anesthetic management for a patient with autoimmune hemolytic anemia

A 69-year-old woman with autoimmune hemolytic anemia (AIHA) received gastric resection and splenectomy under general anesthesia combined with epidural anesthesia. Her blood type had been determined as type A, Rh type CCDee, with anti-e-antibody and anti-pdl-antibody positive as autoantibodies. We applied the technique of hemodilutional autologous transfusion to supplement the blood loss during the operation to prevent hemolysis or occurrence of new antibody after homologous transfusion. We should pay much attention to a patient with AIHA to find signs of peri-operative hemolysis and to give the treatment for hemolysis in early stage. We consider that the hemodilutional autologous transfusion is a useful technique for the anesthetic management of the patient having a rare blood type.     

Laparoscopic splenectomy in congenital hemolytic anemia in children

Experience of 48 laparoscopic splenectomies in children aged from 3 to 14 years with congenital hemolytic anemia is analyzed. The main stages of laparoscopic splenectomy were the following: isolation of the inferior pole of the spleen, transection of the gastro-splenic ligament, transection of the splenic vascular trunk (with endostapler or intracorporeal ligature), dissection of the splenic ligaments, removal of the organ (with endoscopic sac or morcellator). One-stage cholecystectomy for cholelithiasis was performed in 11 patients. Time of surgery was 110-115 minutes, on the average. One-stage cholecystectomy prolonged surgery by 30-40 minutes. There were no intraoperative and postoperative complications. Conversion to open surgery was necessary in 2 cases because of endostapler failure. Patients were discharged on the 5-8th day after surgery. Physical activity restored completely 10-14 days after surgery. There were no lethal outcomes. Excellent cosmetic results were achieved in all the patients. Laparoscopic splenectomy in congenital hemolytic anemia is safe, sparing and effective endoscopic surgery in childhood.     

Surgical treatment of hemolytic anemia]

Splenectomy was done in 448 patients with various forms of hemolytic anemia. Recovery was noted in 362 patients (of them 143 children) with hereditary microspherocytic hemolytic anemia (HMHA). Of 8 patients with hereditary nonmicrospherocytic hemolytic anemia (HNMHA) one died, in 7 general status had improved. Of 78 patients with autoimmune hemolytic anemia (AIHA) 3 died, in 47 (60%) satisfactory result was noted, general status improved--in 18 (23%). If surgical intervention is indicated the operation for HMHA is radical method of treatment, HNMHA--the selective one, and AIHA--one of the main.     

Characteristics of the early postoperative period in patients with hemolytic anemia

In 40 patients with hereditary and acquired hemolytic anemia, the clinico-hematologic remission and improvement of the functional state of the liver was achieved as a result of the complex treatment.     

Acute ventricular septal perforation in a patient with autoimmune hemolytic anemia

A 71-year-old woman with autoimmune hemolytic anemia underwent an emergency endocardial patch repair for ventricular septal perforation after acute myocardial infarction. Use of washed red blood cells was effective in averting hemolytic crisis throughout perioperative period. In spite of improvement of her hemodynamics, liver dysfunction which had been present preoperatively deteriorated after the operation. Finally she died of hepatic failure on the 21th postoperative day. Deterioration of liver function could not be associated with autoimmune hemolytic anemia. To date, little information is available concerning the influence of cardiopulmonary bypass on hemolysis in patients with autoimmune hemolytic anemia. Therefore, prudent management and use of washed red blood cells transfusion would prevent hemolytic aggravation even in open heart surgery.     

难治性溶血性贫血患者利妥昔单抗联合治疗的护理

对3例难治性溶血性贫血患者,采用足量激素、大剂量丙种球蛋白或血浆置换及干细胞移植治疗的同时,联合利妥昔单抗治疗。结果用药过程中未发生不良反应,患者均好转出院。提出做好心理护理、病情观察、血浆置换及输血护理,尤其是药物的观察护理能保证难治性溶血性贫血患者的治疗效果。