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Journal of Obstrectic Anaesthesia and Critical Care
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Year : 2015  |  Volume : 5  |  Issue : 1  |  Page : 30-32

Peripartum management of patient with a rare combination of two bleeding diatheses: Recognizing active role of anesthesiologists during preparatory preemptive prepartum multi-disciplinary conference

Department of Anesthesiology, Wayne State University, Detroit Medical Center, Detroit, Michigan, USA

Correspondence Address:
Dr. Vitaly Soskin
Box No: 162, 3990 John R, Detroit, MI 48201
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2249-4472.155197

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To provide optimal medical care to our patients, it is crucial that all members of operating room team have clear understanding of patients' medical needs and the risks associated with their upcoming surgeries. Multi-disciplinary meetings to establish the best treatment options regarding patient care are not new to medicine. We hereby present a case in which an obstetric patient with a rare combination of two bleeding diathesis was managed using a similar multi-disciplinary approach. A 21-year-old pregnant patient with known von Willebrand's disease type I and platelet storage pool disorder (dense granule deficiency type: Decreased number of granules per platelet) presented to her hematologist for counseling regarding her current pregnancy. Decision was made to convene a multi-disciplinary conference with the panel inclusive of personnel from anesthesiology, adult hematology, pediatric hematology, pediatrics, maternal fetal medicine, obstetrics, pathology and blood bank services along with the patient and her family. The primary concerns of anesthesiologists were whether the patient with rare bleeding diathesis combination can have neuraxial analgesia-anesthesia and how likely the patient may have severe bleeding complications requiring massive blood transfusion protocol. As patient's von Willebrand factor activity was normal (>150%) secondary to pregnancy but platelet function was impaired, the hematologist's recommendations were that patient should receive transfusion of 5 units random donor platelets prior to labor epidural catheter insertion and 5 units random donor platelets prior to removal of epidural catheter left-in-situ for 24 h postdelivery. Anesthesiologists as perioperative physicians are in a unique position to actively participate in multi-disciplinary approach to perioperative patient care. Complex patient scenarios wherein multiple clinicians are concurrently managing these patients can benefit the most from this approach.

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