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Undiagnosed intraoperative methaemoglobinaemia
Swapnil Verma1, A K Sathpathy1, U Srinivas1
1Department of Anaesthesia, Apollo Hospital Jubilee Hills, Hyderabad, Telangana, India.
Indian Journal of Anaesthesia
|February 9, 2018
Summary
Methaemoglobinaemia, a rare blood disorder, can cause dark, chocolate-colored blood unresponsive to oxygen. This case highlights its perioperative detection in a child undergoing surgery, emphasizing its potential for underdiagnosis.
Area of Science:
- Hematology
- Anesthesiology
- Pediatrics
Background:
- Methaemoglobinaemia is a rare but serious hemoglobinopathy.
- It often presents as unexplained cyanosis with dark blood, particularly when cardiac or pulmonary issues are absent.
- It can be an incidental perioperative finding in patients with dark blood unresponsive to oxygen.
Purpose of the Study:
- To report a case of methaemoglobinaemia in a pediatric patient.
- To highlight the diagnostic challenge of this condition, especially during surgery.
- To emphasize the importance of recognizing 'chocolate-colored blood' as a potential sign.
Main Methods:
- Case report presentation.
- Perioperative observation during cochlear implant surgery.
- Clinical presentation of 'chocolate-colored blood' despite normal oxygen levels.
Main Results:
- A child with deaf-mutism presented with dark, 'chocolate-colored blood' during surgery.
- Blood gas analysis revealed a normal partial pressure of oxygen, complicating the diagnosis.
- The finding was incidental and not associated with apparent cyanosis preoperatively.
Conclusions:
- Methaemoglobinaemia should be considered in unexplained 'chocolate-colored blood', even with normal oxygen saturation.
- Perioperative diagnosis can be challenging but is crucial for patient management.
- Early recognition is key to avoiding misdiagnosis and ensuring appropriate treatment.
