Tuesday, June 4, 2013

Thru' the valley of death

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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