ANESTHETIC RISKS IN SICKLE CELL TRAIT

Five Negro children with sickle cell trait died during or shortly after general anesthesia. Their ages were 18 months to 13 years. In four of the five cases sickle cell trait was undiagnosed and asymptomatic. In one, S-C hemoglobinopathy had been diagnosed previously. Four of the deaths were sudden, unexpected, and attributed to cardiac arrest of unknown cause. One was associated with massive hemorrhage and respiratory tract obstruction during surgery. Generalized sickling, widespread vascular occlusions by conglutinated erythrocytes and early parenchymal changes of hypoxia were found at autopsy, suggesting that massive intravascular sickling of red blood cells was present at the time of death and may have been the immediate cause. Circumstances known to promote sickling prevailed. Preoperative screening for sickle cell hemoglobin might have led to different management.