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Case report reveals challenges in oxygen delivery in a patient with anemia and incompatible transfusion, highlighting alternative approaches.
Introduction: Clinical assessment of tissue oxygen delivery is a challenging task for anesthesiologists. Anemia indicates a decrease in the oxygen-carrying capacity of blood, which poses a significant risk for oxygen Delivery Insufficiency (DO2) and cellular hypoxemia and it can be used to assess tissue hypoxia. Blood transfusion is commonly used to correct anemia promptly and efficiently, but in certain circumstances, clinicians may be unable to perform blood transfusion, necessitating the use of alternative therapeutic approaches by anesthesiologists. Case Report: A 20-year-old female presented with anemia, with a hemoglobin (Hb) level of 6.0 g/dL. The patient's clinical and hemodynamic conditions were stable within normal limits and blood transfusion was planned. However, the Comb test results were incompatible, representing an absolute contraindication to transfusion. The patient exhibited clinical changes indicating tissue hypoxia when the Hb level dropped to 2.0 g/dL. The doctor decided to maximize DO2 and reduce oxygen consumption (VO2) to achieve a balance in oxygen requirements. The patient received steroid therapy due to suspected Autoimmune Hemolytic Anemia (AIHA). On the eighth day, the patient showed clinical improvement, stable hemodynamics and an increase in Hb level. Conclusion: Clinical evaluation related to tissue oxygenation distribution is crucial in patients with AIHA.
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Artanto et al. (2023) studied this question.
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