A 21 year old primiparous Afro-Caribbean woman presents with an unbooked pregnancy of 31 weeks’ gestation. She is admitted onto the labour ward with foetal distress and her blood test results are:
– Sickledex positive
– Haemoglobin: 9.2 g/dL
– Mean cell volume: 60 fL
1. What problems might you encounter?
2. What is fL the abbreviation for?
3. How would you interpret the blood test results?
4. What are the important things to consider in sickle cell disease?
5. How would you anaesthetise the patient for an immediate emergency Caesarean section?
Eight hours later you are called to see the patient on the ward. She is complaining of pleuritic chest pain and has a raised respiratory rate and a tachycardia. Her oxygen saturation (SpO2) is 89% and her haemoglobin is now 6.5 g/dL ,with a reticulocyte count of 16%.
What do these signs and symptoms suggest to you, and how would you manage the patient?