Sickle cell disease is a multisystem disease characterised by chronic haemolytic anaemia, painful vasoocclusive crises and acute and chronic end-organ damage. It is one of the most common serious inherited single gene conditions worldwide and has a major impact on the health of affected individuals. Peri-operative complications are higher in patients with sickle cell disease compared with the general population and may be sickle or non-sickle-related. Complications may be reduced by meticulous peri-operative care and transfusion, but unnecessary transfusion should be avoided, particularly to reduce the risk of alloimmunisation. Planned surgery and anaesthesia for patients with sickle cell disease should ideally be undertaken in centres with experience in caring for these patients. In an emergency, advice should be sought from specialists with experience in sickle cell disease through the haemoglobinopathy network arrangements. Emerging data suggest that patients with sickle cell disease are at increased risk of COVID-19 infection but may have a relatively mild clinical course. Outcomes are determined by pre-existing comorbidities, as for the general population.

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It is well recognised that labor is painful. Analgesia is therefore required by the vast majority of parturients during labor and delivery. Central neuraxial blockade is the most effective form of analgesia in labor and also the most desirable type of anesthesia for peripartum operative interventions. Inadequate hemostasis is a contraindication to central neuraxial blockade. This chapter will discuss all forms of analgesia available to the laboring woman with a hemostatic or thrombotic disorder, and the implications of abnormalities of hemostasis, with particular emphasis on central neuraxial blockade.

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IN 1999, a Practitioner in Residence programme was set up at University College Dublin, with the support of Hill's Pet Nutrition, to bring the reality of veterinary practice to students during their clinical rotation. In this article, the views of the participating department, the practitioner, a student and the programme's sponsor are discussed a year down the line.