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Central neuraxial bleeding: case report A 73-year-old woman developed central neuraxial bleeding during treatment with anagrelide and aspirin for for polycythaemia vera. The woman was admitted to the hospital with a complaint of intermittent palpitations, decompensated heart failure with lower limb swelling and progressive exertional dyspnoea. She was newly diagnosed with pulmonary veno-occlusive disease (PVOD) and showed painful incarcerated femoral hernia, which required surgical intervention. She had been receiving anagrelide and aspirin [dosages and routes not stated] and an unspecified phosphodiesterase III inhibitor for polycythemia vera. She was scheduled for an open left femoral hernia repair along with the possibility of conversion to laparotomy and bowel resection under regional anaesthesia with a lumbar combined spinal-epidural (CSE). However, the procedure was challenging owing to the presence of lumbar scoliosis. She had received her last dose of anagrelide 8 hours prior to the surgery and aspirin was withheld 24 hours prior to the surgery. The lumbar CSE was completed uneventfully under concomitant central neuraxial anaesthetics (including bupivacaine and lidocaine [lignocaine]), fentanyl and sodium bicarbonate. She remained haemodynamically stable throughout the surgery. However, significant central neuraxial bleeding from the CSE puncture site was observed immediately post-operatively secondary to aspirin and anagrelide therapy. The bleeding complicated to central neuraxial haematoma [durations of treatments to reactions onsets not stated]. The woman’s anagrelide was discontinued for 72 hours following the CSE anaesthesia and received external manual compression. She was then observed in the post anaesthesia care unit for 1 hour until the full neurological recovery was established. No further bleeding from the catheter insertion site was observed during this period. Postoperatively, her coagulation profile remained normal. She was discharged on postoperative day 7. Foong TW, et al. Anesthesia for pulmonary veno-occlusive disease: the dilemma and what we should know as anesthesiologists: A case report. Medicine 99: No. 30, 24 Jul 803501457 2020. Available from: URL: http://doi.org/10.1097/MD.0000000000021517

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