retinal haemorrhages, exudates, disc pallor, optic atrophy, neuritis, retinal detachment and papilloedema. 1 The features of anaemic retinopathy seem to be universal, irrespective of the cause of the anaemia. The retinopathy also seems to resolve once the anaemia is corrected, as shown in the patient presented. It is widely believed that anaemia causes diminished capillary oxygenation, which increases the vessel wall permeability resulting in extravasation of blood products. 2 There seems to be a direct correlation between the degree of anaemia and the severity of the retinopathy. Aplastic anaemia is a life threatening condition. It usually presents with anaemia, bleeding and infection. It can be inherited but it is more commonly acquired. The ocular findings include cotton wool spots, nerve fibre layer or preretinal haemorrhages, vitreous haemorrhages and optic disc oedema. Mansour et al. reported ocular findings in 18 patients with aplastic anaemia. 3 In their report, the patients were known to be anaemic prior to the development of the retinopathy. In our case, the patient certainly had disc oedema and nerve fibre layer haemorrhages with gross macular oedema, all of which resolved once the anaemia was corrected. Some patients with aplastic anaemia also develop pseudotumour cerebi which may require treatment geared towards lowering the raised intracranial pressure. 4-6 It has been suggested that papilloedema associated with aplastic anaemia could be due to increased intracranial pressure from anaemia-induced cerebral hypoxia. 7 The presentation in this patient initially was suggestive of raised intracranial pressure. We feel it is important that clinicians are made aware of this unusual presentation and that this case might hopefully help direct treatment to the underlying cause.

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We read with interest the study by Shippam et al. [1] regarding high-flow humidified nasal oxygen (HFNO) for pre-oxygenation of pregnant women in preparation for general anaesthesia. The findings from this study do not support the use of HFNO to pre-oxygenate term pregnant women. The primary end-point used was an end-tidal oxygen fraction (F ET O 2 ) ≥ 0.9 which is a recommended target for pre-oxygenation by the Obstetric Anaesthetists' Association [2] and the Difficult Airway Society. However, with the advancement in the use of HFNO as an adjunct in both pre-oxygenation and apnoeic oxygenation, should this target be revised? The use of HFNO maximises the physiological phenomenon of aventilatory mass flow, driving oxygen into the lungs and flushing out other dead space gases present [3]. This, coupled with the splinting of upper airways and reduction in associated shunt, can improve oxygenation [3].If this is the case, then is it a prerequisite to preoxygenate to a value of F ET O 2 ≥ 0.9 in a situation where we can continually replenish our oxygen stores via continuous HFNO? If the patency of the airway can be maintained can HNFO redefine our end-point for pre-oxygenation?