Successful management of massive blood loss to extremely low hemoglobin in an elderly woman receiving spinal surgery.

Blood transfusion is absolutely indicated in acute anemia when the hemoglobin concentration falls below 6 g/dL. Sometimes it challenges the anesthesiologists if the blood intended for urgent transfusion is not readily or quickly available. In this case report, we describe an 81-year-old lady who accidentally sustained acute anemia after spinal surgery with the hemoglobin concentration falling to 1.4 g/dL. During the long wait for the process of cross-matching tests and delivery of blood from the blood bank in the city remote from the hospital, we could do nothing but administer crystalloid and colloid solutions to maintain the circulatory volume to prevent low cardiac output. Epinephrine was given when systolic blood pressure fell below 70 mmHg. Central venous pressure and arterial blood pressure were monitored to guide all the treatment. Fortunately, patient fully recovered on postoperative day 3 without any adverse events.