Tomorrow is LSCS of my sister and today is admitted is there necessary to do cBc , PT , INR, today it is done on 1 june . So tell me what to do . Patient is history of sickling cell disease
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sickle cell disease LSCS preoperative CBC PT INR repeat how many days valid before surgery
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Now I have solid clinical information. Let me put together a thorough, practical answer.
Pre-op Labs for LSCS Tomorrow - Sickle Cell Disease Patient
Here is a clear breakdown of what needs to be done:
Are the June 1st Labs (Done 2 Days Ago) Still Valid?
Yes, they are generally acceptable - but with important caveats for sickle cell disease.
For most stable patients, pre-op labs (CBC, PT/INR) are considered valid for up to 30 days before elective surgery. Labs done just 2 days ago on June 1st are within acceptable range for a patient being admitted the day before surgery.
However, sickle cell disease is a high-risk special condition where clinical status can change rapidly (crisis, acute chest syndrome, sudden hemolysis). The standard guidance is:
"Patients with sickle cell disease are often admitted the day before surgery" - Barash's Clinical Anesthesia, 9e, p.1898
Because your sister was admitted today, the care team should review and reassess the June 1st results in context of her current condition today.
What to Do Right Now (Today - June 3rd)
| Action | Priority |
|---|---|
| Review CBC from June 1st - check current Hb level | Mandatory |
| Repeat CBC today if any clinical change (fever, pain crisis, new symptoms) | Strongly recommended |
| Hb target before surgery is ≥10 g/dL - if below, hematology consult needed | Mandatory |
| PT/INR from June 1st - acceptable if no liver disease, no anticoagulants, no new bleeding | Usually sufficient |
| Type and Crossmatch - must be done fresh before LSCS | Mandatory - do TODAY |
| Hematology consult if not already done | Strongly recommended |
| Echocardiogram if history of respiratory/cardiac symptoms or pulmonary hypertension | As clinically indicated |
Why Sickle Cell Makes This Different
Sickle cell patients undergoing surgery (including Caesarean section) are at high risk for:
- Acute Chest Syndrome (ACS) - 3% perioperative risk
- Vaso-occlusive crisis (VOC)
- Stroke
- Sudden death
The pre-op goal is:
- Hemoglobin ≥ 10 g/dL (simple transfusion may be needed if Hb is below this)
- Avoid Hb > 12 g/dL (increases blood viscosity, worsens sickling)
- Crossmatched blood must be available in the blood bank before the case starts (alloimmunization in SCD makes crossmatching time-consuming - this is why it must be done today, not in the morning)
From Barash's Clinical Anesthesia, 9e: "The goal of preoperative RBC transfusion is to achieve a hemoglobin level of at least 10 g/dL... There is a high incidence of alloimmunization among SCD patients and obtaining cross-matched RBCs can be time-consuming."
Perioperative Points for the Team to Know
- Spinal anesthesia is preferred for Caesarean section in SCD - it reduces blood loss and postoperative narcotic need (monitor for hypotension)
- Maintain normovolemia - avoid dehydration (fasting time should be minimized)
- Maintain normothermia
- Avoid vena caval compression - left lateral tilt positioning is important in pregnancy
- Avoid hypoxia, hypothermia, acidosis, stasis - all trigger sickling
Bottom Line
- CBC from June 1st: Acceptable if patient is clinically stable. Repeat today if any concern (pain, fever, breathlessness)
- PT/INR from June 1st: Acceptable unless she is on anticoagulants or has liver disease
- Type and Crossmatch: Must be sent TODAY - this is the urgent one
- Call hematology if not already involved in the care
- Check Hb - if < 10 g/dL, she may need a preoperative transfusion before tomorrow's LSCS
Please make sure the obstetrician, anesthesiologist, and ideally a hematologist are all aware of the sickle cell history before tomorrow. I hope her surgery goes well.
Disclaimer: This is clinical educational information. Final decisions on investigations and management must be made by the treating doctors who have examined the patient.
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