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First Experience in Living Liver Donation From Donors With Sickle Cell Trait. Transplant Direct 2022; 8:e1332. [PMID: 35557991 PMCID: PMC9088231 DOI: 10.1097/txd.0000000000001332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/03/2022] [Indexed: 11/25/2022] Open
Abstract
Living donor liver transplantation is the main source of organs in the Middle East. Therefore, well balanced criteria are needed to avoid unnecessary exclusion of potential donors, while prioritizing donor safety. We face a high incidence of sickle cell trait (SCT; and disease). Therefore, there is vast experience in general and cardiac surgeries in SCT carriers at our center. After studying their management in detail, we considered accepting SCT carriers as living liver donors, on an exceptional basis. This the first single-center case series of living donor liver transplantation with SCT.
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Koh LY, Hwang NC. Red-Colored Urine in the Cardiac Surgical Patient-Diagnosis, Causes, and Management. J Cardiothorac Vasc Anesth 2020; 35:3774-3788. [PMID: 33199113 DOI: 10.1053/j.jvca.2020.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 11/11/2022]
Abstract
Red-colored urine occurring in the intraoperative and early postoperative periods after cardiac surgery is often a cause for concern. This observation may be a result of hematuria from pathology within the urinary tract, anticoagulant-related nephropathy, drug-induced acute interstitial nephropathy, excretion of heme pigment-containing proteins, such as myoglobin and hemoglobin, and hemolysis occurring during extracorporeal circulation. Within the kidneys, heme-containing compounds result in pigment nephropathy, which is a significant contributory factor to cardiac surgery-associated acute kidney injury. Concerted efforts to reduce red blood cell damage during cardiopulmonary bypass, together with early recognition of the at-risk patient and the institution of prompt therapeutic intervention, may improve outcomes. This review addresses the diagnosis, causes, and management of red-discolored urine occurring during and after cardiac surgery.
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Affiliation(s)
- Li Ying Koh
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore
| | - Nian Chih Hwang
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore.
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Naik RP, Smith-Whitley K, Hassell KL, Umeh NI, de Montalembert M, Sahota P, Haywood C, Jenkins J, Lloyd-Puryear MA, Joiner CH, Bonham VL, Kato GJ. Clinical Outcomes Associated With Sickle Cell Trait: A Systematic Review. Ann Intern Med 2018; 169:619-627. [PMID: 30383109 PMCID: PMC6487193 DOI: 10.7326/m18-1161] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Although sickle cell trait (SCT) is largely a benign carrier state, it may increase risk for certain clinical outcomes. Purpose To evaluate associations between SCT and clinical outcomes in children and adults. Data Sources English-language searches of PubMed, CINAHL, the Cochrane Library, Current Contents Connect, Scopus, and Embase (1 January 1970 to 30 June 2018) and bibliographies of review articles. Study Selection Observational controlled studies (published in English) in children or adults that examined an association between SCT and any of 24 clinical outcomes specified a priori in the following 6 categories: exertion-related injury; renal, vascular, pediatric, and surgery- or trauma-related outcomes; and overall mortality. Data Extraction A single reviewer extracted study data, which was checked by another; 2 reviewers independently assessed study quality; and strength of evidence was assessed by consensus. Data Synthesis Of 7083 screened studies, 41 met inclusion criteria. High-strength evidence supported a positive association between SCT and risk for pulmonary embolism, proteinuria, and chronic kidney disease. Moderate-strength evidence supported a positive association between SCT and exertional rhabdomyolysis and a null association between SCT and deep venous thrombosis, heart failure or cardiomyopathy, stroke, and pediatric height or weight. Absolute risks for thromboembolism and rhabdomyolysis were small. For the remaining 15 clinical outcomes, data were insufficient or strength of evidence was low. Limitation Publication bias was possible, and high-quality evidence was scant. Conclusion Sickle cell trait is a risk factor for a few adverse health outcomes, such as pulmonary embolism, kidney disease, and exertional rhabdomyolysis, but does not seem to be associated with such complications as heart failure and stroke. Insufficient data or low-strength evidence exists for most speculated complications of SCT. Primary Funding Source National Human Genome Research Institute.
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Affiliation(s)
| | - Kim Smith-Whitley
- Children’s Hospital of Philadelphia and University of
Pennsylvania, Philadelphia, Pennsylvania
| | | | - Nkeiruka I. Umeh
- National Human Genome Research Institute of the National Institutes
of Health, Bethesda, Maryland
| | | | - Puneet Sahota
- Children’s Hospital of Philadelphia and University of
Pennsylvania, Philadelphia, Pennsylvania
| | - Carlton Haywood
- University of Pennsylvania, Philadelphia, Pennsylvania; Johns
Hopkins Berman Institute of Bioethics, Baltimore, Maryland
| | - Jean Jenkins
- National Human Genome Research Institute of the National Institutes
of Health, Bethesda, Maryland
| | | | | | - Vence L. Bonham
- National Human Genome Research Institute of the National
Institutes of Health, Bethesda, Maryland
| | - Gregory J. Kato
- Vascular Medicine Institute at the University of Pittsburgh School
of Medicine, Pittsburgh, Pennsylvania
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Crawford TC, Carter MV, Patel RK, Suarez-Pierre A, Lin SZ, Magruder JT, Grimm JC, Cameron DE, Baumgartner WA, Mandal K. Management of sickle cell disease in patients undergoing cardiac surgery. J Card Surg 2017; 32:80-84. [DOI: 10.1111/jocs.13093] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Todd C. Crawford
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Michael V. Carter
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Rina K. Patel
- Division of Hematology, Department of Medicine; Greater Baltimore Medical Center; Baltimore Maryland
| | - Alejandro Suarez-Pierre
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Sophie Z. Lin
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Jonathan Trent Magruder
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Joshua C. Grimm
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Duke E. Cameron
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - William A. Baumgartner
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Kaushik Mandal
- Division of Cardiac Surgery Baltimore, Department of Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
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Maddali MM, Rajakumar MC, Fahr J, Albahrani MJ, Amna MA. Cardiopulmonary Bypass without Preoperative Exchange Transfusion in Sicklers. Asian Cardiovasc Thorac Ann 2016; 14:51-6. [PMID: 16432120 DOI: 10.1177/021849230601400113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effect of hypothermic cardiopulmonary bypass techniques on the sickling process was evaluated in patients with sickle cell hemoglobin. It was presumed that intraoperative hemolysis, as identified by hemoglobinuria, reflected increased sickling. Data of 43 patients with sickle cell traits and 2 with sickle cell disease, who were operated on under cardiopulmonary bypass and cold cardioplegic arrest in a tertiary center from the beginning of 1995 to the end of 2004, were retrospectively analyzed. A mean nasal temperature of 30.8°C ± 2.1°C was achieved. Three patients with sickle cell trait developed intraoperative hemoglobinuria, albeit with normal surrogate values for hemolysis. However, they had significantly lower mean hemoglobin levels during cardiopulmonary bypass compared to those sickle cell patients who did not exhibit hemoglobinuria (hemoglobin, 6.0 ± 0.2 vs. 7.4 ± 0.9 g·dL−1, p < 0.01). Total drainage and blood transfusion requirements in patients with normal and sickle cell hemoglobin were similar. It was concluded that hypothermic cardiopulmonary bypass with cold cardioplegia is safe in sickle cell patients. Maintenance of adequate hemoglobin levels during cardiopulmonary bypass may be important to avoid triggering a sickling process.
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Affiliation(s)
- Madan M Maddali
- Department of Anesthesia, Department of Cardiothoracic Surgery, Royal Hospital, Muscat, Sultanate of Oman.
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Farooqui F, Chaney MA, Staikou C, Cole SP. CASE 10-2016: Hemoglobinopathies and Cardiac Surgery. J Cardiothorac Vasc Anesth 2016; 30:1409-18. [PMID: 27640894 DOI: 10.1053/j.jvca.2016.03.156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Farhan Farooqui
- Department of *Anesthesia and Critical Care, The University of Chicago, Chicago, IL
| | - Mark A Chaney
- Department of *Anesthesia and Critical Care, The University of Chicago, Chicago, IL.
| | | | - Sheela Pai Cole
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
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Díaz-Pache MVA, Sarrión Bravo MV, Silva Guisasola J, Ariño Irujo J, López Timoneda F. [Treatment of a female patient with sickle-cell anemia during cardiac surgery with cardiopulmonary bypass]. ACTA ACUST UNITED AC 2011; 58:454-7. [PMID: 22046869 DOI: 10.1016/s0034-9356(11)70111-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 17-year-old girl with drepanocytic (sickle-cell) anemia who was being treated with hydroxyurea and periodic blood transfusions through a Hickman-type catheter was admitted for periodic episodes of fever. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Massive right atrial thrombosis with pulmonary embolism and bacterial endocarditis were detected by computed tomography. Surgery with a beating heart and cardiopulmonary bypass was undertaken. Drepanocytic anemia in individuals homozygous for hemoglobin S is a rare condition in Spain but we are beginning to see a few cases, in which management during anesthesia will be more complicated. High-risk surgery can be carried out in these patients without adverse events if the anesthesiologist is guided by a complete blood workup and takes precautions during and after surgery to control hydration, oxygenation, temperature, and the acid-base balance.
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Affiliation(s)
- M V Acedo Díaz-Pache
- Servicio de Anestesiología y Reanimación, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid.
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Adhikari RK, Maddali MM, Zacharias S. Preoperative Exchange Transfusion for Sickle Cell Disease Patients Undergoing Open-Heart Surgery: An Exception to the Rule. J Card Surg 2010; 25:691-3. [DOI: 10.1111/j.1540-8191.2010.01102.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yousafzai SM, Ugurlucan M, Al Radhwan OA, Al Otaibi AL, Canver CC. Open heart surgery in patients with sickle cell hemoglobinopathy. Circulation 2010; 121:14-9. [PMID: 20026775 DOI: 10.1161/circulationaha.109.882464] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with sickle cell trait or disease, reduced life expectancy and a tendency for complications are believed to negatively affect likelihood of survival after open heart surgery. The aim of this study was to review retrospectively the perioperative results of patients undergoing cardiac surgery at our institution. METHODS AND RESULTS Between January 1995 and December 2006, 47 patients with either sickle cell disease or sickle cell trait underwent open heart surgery at our institution. The average age of the 29 male and 18 female patients was 20 years. Patient outcomes were analyzed through the use of the institutional database. Clinical and echocardiographic follow-up was complete in all patients except 3, with a mean follow-up period of 46 months. Current status could be confirmed in 32 patients. The most common operations included the treatment of congenital and valvular heart diseases. There were no coronary artery bypass grafting procedures. Average weight of the patients was 45 kg. Exchange transfusion was performed both preoperatively and during surgery. Mean preoperative hemoglobin S concentration was 30.4 + or - 3.2% and decreased to 8.1 + or - 2.6% while on pump. Average on-pump hematocrit value was 25.4 + or - 3.7%; in the postoperative period, it increased to 32.7 + or - 4.9%. Mean cardiopulmonary bypass and cross-clamp times were 95 and 69 minutes, respectively. None of the patients had sickling crisis or acidosis. Postoperative complications included exploration for hemorrhage in 3 patients (6.4%), stroke in 2 patients (4.3%), renal failure in 2 patients (4.3%), and prolonged ventilation in 1 patient (2.1%). Average hospital stay was 8.3 days (range, 4 to 27 days). Early in-hospital death occurred in 1 patient (2.1%); currently, 31 patients (66%) remain alive and free of cardiac symptoms. CONCLUSIONS Heart valve surgery and surgery for congenital heart diseases can be performed safely in patients with sickle cell disease or sickle cell trait with acceptable outcome and survival rates.
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Affiliation(s)
- Sajjad M Yousafzai
- King Faisal Heart Institute, MBC-16, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh 11211, Kingdom of Saudi Arabia
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Usman S, Saiful FB, DiNatale J, McGinn JT. Warm, beating heart aortic valve replacement in a sickle cell patient. Interact Cardiovasc Thorac Surg 2010; 10:67-8. [DOI: 10.1510/icvts.2009.214395] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
Hemoglobinopathies are diseases involving abnormalities of the structure or production of hemoglobin. Examples include sickle cell disease, the thalassemias, and rare hemoglobin variants producing cyanosis. Recent advances in the understanding of the consequences of hemoglobin dysfunction on nitric oxide signaling have led to a reassessment of the pathophysiology of sickle cell disease and thalassemia. Chronic vascular inflammation and damage is now recognized as playing an important role in disease expression. Hemoglobinopathies may present to the anesthesiologist as the primary cause of a surgical procedure, as an incidental complicating factor of a surgical patient, or with a problem arising from the disease itself. This article reviews the common types of hemoglobinopathies, presents a basic summary of the pathophysiology relevant to anesthesia, and outlines current perioperative management.
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Borgwardt L, Zerahn B, Bliddal H, Christiansen C, Sylvest J, Borgwardt A. Similar clinical outcome after unicompartmental knee arthroplasty using a conventional or accelerated care program: a randomized, controlled study of 40 patients. Acta Orthop 2009; 80:334-7. [PMID: 19513890 PMCID: PMC2823215 DOI: 10.3109/17453670903035559] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
UNLABELLED BACKGROUND AND PURPOSE Over the last 5 years, there has been increasing interest in reducing length of hospitalization (LOS) through accelerated programs. We examined the clinical outcome of patients undergoing a unicompartmental knee replacement (UKR) in an accelerated care program (A group) compared to a conventional care program (C group). METHODS 40 patients randomized into 2 groups were included (A group: 17 patients; C group: 23 patients). Nausea, micturition problems, lower limb dysfunction, pain (VAS), opiate consumption, Knee Society score (KSS), day of discharge, rehospitalization within 3 months, contact with a general physician or nurse, and level of satisfaction were registered. Patients in the A group attended an information meeting. An intraarticular infiltration with Marcaine and adrenaline was used peroperatively. Patients in the C group had an epidural pump for 2 or 3 days. Patients in the A program were treated with NSAID and paracetamol postoperatively. Opiates were used in both groups in the case of breakthrough pain. The patients were considered ready for discharge when they were able to climb stairs to the second floor within 5 min. RESULTS The median length of stay was 1 (1-3) day in the A group and 6 (4-7) days in the C group. The median pain score (VAS) at day 0 was 1 (0-3) in the A group and 5 (0-8) in the C group (p < 0.001). 11/23 of the patients in the C group had weakness of the lower limbs on day 1 due to the epidural; all patients in the A group were exercising on the day of the operation. Micturition problems necessitating intermediate catherization were more frequent in patients in the C program (19/23) than in patients in the A programme (3/17) (p = 0.001). There were no statistically significant differences between the two groups concerning nausea, average pain on days 1 and 2, use of opioids (during the first week postoperatively), KSS, contact with primary sector, level of satisfaction, or level of confidence. INTERPRETATION We achieved a reduction in LOS of 5 days without affecting the clinical outcome.
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Affiliation(s)
- Lotte Borgwardt
- Department of Orthopaedic Surgery, Frederiksberg University HospitalDenmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University HospitalHerlevDenmark
| | - Henning Bliddal
- The Parker Institute, Frederiksberg University HospitalDenmark
| | | | - Jesper Sylvest
- Department of Rheumatology, Frederiksberg University HospitalDenmark
| | - Arne Borgwardt
- Department of Orthopaedic Surgery, Frederiksberg University HospitalDenmark
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Prielipp RC, Butterworth JF. Clinical Guidelines. Anesth Analg 2000. [DOI: 10.1213/00000539-200002000-00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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