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Central neuraxial blockade for splenectomy in myeloproliferative disease: a word of caution

In Indian Journal of Anaesthesia
By: Myatra SN.
Contributor(s): Kothekar A | Siddiqui SS | Divatia JV.
Material type: materialTypeLabelArticlePublisher: Mumbai : Medknow 2015Description: .Subject(s): Epidural | Myelofibrosis | Portal vein thrombosis | Splenectomy | Thrombolysis | Venous thrombosisOnline resources: PDF In: Indian Journal of Anaesthesia Vol.59, no.10,p.670-2Summary: 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.
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Articles Articles Tata Memorial Hospital
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Address for Correspondence: sheila150@hotmail.com

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.

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