RD was a
very non-suspecting high risk antenatal patient. The issue was with her
hemoglobin. It never crossed 8 gm%.
However,
considering her family’s financial situation, wehad decided to take her at NJH
for delivering her baby by Cesarian section. This was her second baby and her
first baby also was delivered by Cesarian section.
None of us
had any inkling of the crisis we were going to face.
She had a
blood transfusion before the surgery. Unfortunately, the doctor who operated
did not do a repeat hemoglobin value before taking her in for surgery.
Per-operatively, she developed a reaction to the blood transfusion. There was
nothing much of a problem.
After the
surgery, she was comfortable. However, there was a nagging issue. She was not
maintaining her saturation. However, the saturations became normal when oxygen
was given. A hemoglobin done on her turned up a value of 6.6 gm%.
Alarm bells
started to ring on my head. We decided to wait overnight.
The
decision turned out to be almost fatal. She started to have breathlessness in
the night. Her saturations took a dip for the worse. She was going into
pulmonary edema.
By morning,
she was in the ventilator. But, she was also putting out pink frothy sputum. We
had to give about 1 gm of Furosemide over the first 24 hours to control the
pulmonary edema.
By God’s
grace, she responded well to treatment.
And she got
discharged last Sunday, exactly 7 days after her surgery.
However, RD’s
incident has prompted me to put in strict control on hemoglobin values of our
prospective patients. Anemia is quite prevalent in our part of the country. It
is not very common for a pregnant lady to have a hemoglobin of above 10 gm%.
Meanwhile,
the debate on anemia always cause me to wonder if we have some form of a blood
dyscrasia in our part of the country, which is not yet diagnosed.
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