Open AccessCentral neuraxial blockade for splenectomy in myeloproliferative disease: A word of caution
Author(s) -
Sheila Nainan Myatra,
Amol T Kothekar,
Suhail Sarwar Siddiqui,
JV Divatia
Publication year - 2015
Publication title -
indian journal of anaesthesia/indian journal of anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.645
H-Index - 30
eISSN - 0976-2817
pISSN - 0019-5049
DOI - 10.4103/0019-5049.167493
Subject(s) - medicine , splenectomy , neuraxial blockade , thrombolysis , blockade , myeloproliferative neoplasm , thrombosis , portal vein thrombosis , surgery , anesthesia , myelofibrosis , bone marrow , spleen , receptor , spinal anesthesia , myocardial infarction
We describe management of portal vein thrombosis (PVT) in a patient with myeloproliferative disease after splenectomy. This case posed a unique therapeutic challenge in maintaining a fine balance between life-saving thrombolysis and the risk of neuraxial complications due to bleeding. The incidence of PVT after splenectomy in patients with myeloproliferative disorders is high (40%). Anaesthesiologists should be aware of this and avoid central neuraxial blockade in such cases. If post-operative emergency thrombolysis is required in a patient having an epidural catheter in situ, it should be done under close monitoring, weighing the risks and benefits. Fibrinogen levels should be monitored to evaluate the presence of residual thrombolytic effects and to time the catheter removal.