Publication: Anesthetic Management of a Case of Hemophagocytic Lymphohistiocytosis
Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
Institute of Medicine
Abstract
ABSTRACT
Hemophagocytic Lymphohistiocytosis (HLH) is characterized by an overwhelming activation of histiocytes and T lymphocytes leading to fulminant hemophagocytosis and organ damage. Anesthetic management of patients with HLH is associated with challenges such as pancytopenia, hemodynamic instability and infections. In addition to sepsis, metabolic acidosis, disseminated intravascular coagulation, multi-organ involvement with an exacerbation of symptoms with the use of anesthetic agents poses significant risk perioperatively. We present a case planned for excision of pilonidal sinus. The surgery was performed after thorough workup and with the patient in remission. Elective procedures should ideally be performed with patients in remission. Cases receiving concurrent therapy with immunomodulators and steroids require special attention due to possible interaction with anesthetic agents and the need for perioperative steroid supplementation.
Keywords: Anesthetic management, hemophagocytic lymphohystiocytosis, pancytopenia, steroids
Description
Gentle S Shrestha1, Harmeet Gulati2, Binita Acharya1, Bishesh S Poudyal3
1Department of Anesthesiology, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Institute Of Medicine, Maharajgunj, Kathmandu, Nepal
2Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
3Civil Service Hospital, Kathmandu, Nepal
Keywords
Anesthetic management, hemophagocytic lymphohystiocytosis, pancytopenia, steroids