Perioperative Hypertension and Convulsion After Splenectomy in Thalassemic Patient : A Case Report
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Abstract
Perioperative hypertension was observed to be a major problem in thalassemic patients who had splenectomy and some of them progressively developed convulsion and cerebral hemorrhage. Etiology of perioperative hypertension in these patients is still unknown but it was speculated that manipulation of the large spleen might cause splenic contraction which produced autotransfusion and then some mediators might be released.
A 15-year-old female patient with thalassemia was admitted for splenectomy. During operation 5 her blood pressure rose between 120/80 - 140/90 mmHg After operation she had more extensive hypertension between 140/90 - 150/90 mmHg and developed convulsion 2 hours after operation. CT brain scan was conducted with no evidence of cerebral hemorrhage. She received furoxemide for hypertension and diazepam for convulsion. Her blood pressure gradually declined and return to normal 24 hours after operation. She was discharged 7 days after operation without any sequelae.
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2. Cavill I, Ricketts c, Jacops A, Letsky E.Erythropoiesis and effect at transfusion in homozygous beta-thalassemia. N Engl J Med 1978;298:776-8
3. Orr D.Difficult intubation : A hazard in thalassemia. A case report .Br J Anaesth 1967;39:585-6
4. Jootar P, Fucharoen S. Cardiac involvement in beta-thalassemia hemoglobin E disease : Clinical and hemodynamic findings. Southeast Asian J Trop Med Publ Health 1990;21:269-73
5. Suwanchinda V, Tengapirak Y. Udomphunthurak S. Hypertension perioperative splenectomy in thalassemic children. J Med Assoc Thai 1994 Feb ; 77(2:66-70
6. Wasi P, Na-Nakorn S, Pootrakul P, Sonakul D, Piankijagum A, Pacharee P. A syndrome of hypertension,convulsion and cerebral hemorrhage in thalassemic patients after multiple blood transfusion. Lancet 1978 Sep; 2(8090):602-4
7. Sonakul D, Fucharoen S. Brain pathology in 6 fatal cases at posttransfusion hypertension, convulsion and cerebral hemorrhage syndrome. Southeast Asian J Trop Med Publ Health 1992;23 Suppl 2 : 116-9
8. Chuansumrit A, Isarangkura P, Hathirat P, Thirawarapan S. A syndrome of post-transfusion convulsion and cerebral hemorrhage in betathalassemia hemoglobin E disease : A case report with high plasma renin activity. J Med Assoc thai 1986 Oct 69 Suppl 2:1-5
9. Thirawarapan S, Snongchart N, Fucharoen S,Tanphaichitr V, Dhorranintra B. Study of mechanisms of post-transfusion in thalassemic patients. Southeast Asian J Trop Med Publ Health 1989 Sep ; 20(3):471-8
10. Suwanchinda V, Pirayavaraporn S, Yokubol B, Tengapirak Y, Laohapensang M, Udomphunthuruk S. Does furoxemide prevent hypertension during perioperative splenectomy in thalassemic children? J Med Assoc Thai 1995 Oct;78(10):542-6
11. Suwanchinda V, Pirayavaraporn S, Laohapensang M, Tanphaichitr V, Somprakit P. Hemodynamic responses to captopril during splenectomy in thalassemic children. J. Med Assoc Thai 1999 Jul ; 82(7):666-71
