Anaesthetic Management in an Adult Thalassemia Major Patient Undergoing Splenectomy: A Case Report

Thalassemia major patient requires multiple transfusions therefore splenectomy is a common surgery performed in this group of patients to decrease the frequency of transfusion and mechanical effect of enlarged spleen. Anaesthetic management in these patients are challenging being associated with unanticipated difficult airway, cardiac diseases, restrictive respiratory pattern, perioperative high blood pressure, endocrinological abnormalities, iron overload and pulmonary hypertension. We report a case report of anaesthetic management in an adult thalassemia major patient with massive splenomegaly posted for splenectomy. A 25 year old female, suffering from thalassemia major since the age of six months, with increasing frequency of blood transfusions ranging from once in a month to once in a week and presently upto twice in a week. She presented with chief complaints of pain and mass per abdomen, which was gradually progressive since last one and a half year. Systemic examination revealed prominent abdominal veins, hepatomegaly 10 cm below right costal margin (RCM) and splenomegaly 15 cm below left costal margin (LCM). Ultrasonography suggested liver measuring 23 cm with fatty infiltration and spleen measuring 23 cm with splenic vein diameter of 13mm. She was given general anaesthesia for the surgery. Many case reports in medical literature are about anaesthetic management of paediatric thalassemia major patients undergoing splenectomy and some case reports of anaesthetic management in adult beta thalassemia intermedia (milder disease) patients undergoing splenectomy. To the best of our knowledge, this is the first case report of anaesthetic management in an adult female with thalassemia major undergoing splenectomy.