Indian Journal of Anaesthesia (Jan 2018)

Robotic hysterectomy in Trendelenburg position in a severely anaemic JKa alloimmunised patient with impending high-output cardiac failure: An anaesthetic challenge

  • Shagun Bhatia Shah,
  • Ajay Kumar Bhargava,
  • Rajiv Chawla,
  • Amardeep Pathak

DOI
https://doi.org/10.4103/ija.IJA_5_18
Journal volume & issue
Vol. 62, no. 5
pp. 385 – 388

Abstract

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Kidd blood group alloimmunisation, though extremely rare, may produce considerable morbidity, and even mortality. Severe anaemia and impending high-output cardiac failure requiring blood transfusion should be weighed against the risk of severe transfusion reactions even with fully cross-matched blood. Kidd antibodies are a common cause of delayed haemolytic transfusion reaction (DHTR) since they have a tendency remain undetectable in plasma. A low -grade DHTR (second hit) was grossly amplified by a second DHTR (third hit) superimposed on it in our patient leading to severe haemolysis with serum bilirubin reaching 68 mg%. Indirect antiglobulin test (indirect Coombs reaction) should ideally be performed in all patients (scheduled for major surgery requiring blood transfusion) who have experienced a previous pregnancy or blood transfusion. Non-invasive continuous haemoglobin monitoring and non-invasive cardiac output monitoring can prove invaluable tools in management.

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