WALKING THE TIGHTROPE: NAVIGATING ANESTHETIC CHALLENGES IN A PEDIATRIC CARDIAC SURGERY CASE WITH PORTAL HYPERTENSION AND SEVERE THROMBOCYTOPENIA

Abstract

Background: Anesthetic management of pediatric patients for corrective cardiac surgery is highly complex when portal hypertension, severe thrombocytopenia and inherited thrombophilia coexist. The interplay between bleeding and thrombotic risks requires meticulous planning.

Case report: We present the case of a 5-year-old child with congenital heart disease and severe thrombocytopenia who was scheduled for corrective cardiac surgery. The child was hospitalized for the first time 6 months earlier because of a sudden abdominal pain and hematemesis, leading to the diagnosis of portal hypertension and inherited thrombophilia. At the time he presented for surgery, the child had very low platelets, 36x10^9/L with no other abnormalities in the laboratory results. Anesthetic management focused on balancing hemorrhage and thrombosis, optimizing coagulation with viscoelastic testing, goal-directed transfusion therapy and maintaining stable hemodynamics. Surgery was completed successfully, with close postoperative monitoring in the pediatric cardiac ICU.

Conclusion: This case highlights the challenges of managing a child with combined bleeding and thrombotic risks. Individualized anesthetic strategies and multidisciplinary approach are essential to achieve safe outcomes in such high-risk background.