Patients with a haemoglobin of greater than 8 g/dl may travel without problems assuming there is
no coexisting condition such as cardiovascular or respiratory disease. If the haemoglobin is less
than 7.5 g/dl, special assessment should be made and the use of supplemental oxygen should be
Individuals with chronic renal insufficiency or other medical condition predisposing to anaemia,
which is chronic in nature, will usually tolerate a lower haemoglobin level than if the anaemia is
of acute onset. Sickle cell trait does not present a particular problem at normal cruising
altitude. However, patients with sickle cell anaemia should travel with supplemental oxygen and
should defer travel for approximately 10 days following a sickling crisis.
Deep venous thrombosis is not intrinsically dangerous but the complications of pulmonary
embolism can be life threatening. It has been shown that DVT can occur in many other forms of
travel, as described by Homans in 1954. The World Health Organisation Research into Global Hazards
of Travel (Wright) Project recently reported and the key determinant for deep venous thrombosis is
immobilisation and the risk of thrombosis is increased by travel of greater than 4 hours. Therefore
“travellers’ thrombosis” is the most appropriate term to use, rather than “economy class syndrome”.
There is no evidence that the cabin environment activates the coagulation system of normal
individuals. The absolute risk, as shown in the Wright Study, was one in 4656 flights of more than
4 hours duration.
The risk factors for thrombosis are well known and are listed below:
Prophylactic measures should be undertaken according to the degree of risk. Simple, effective
measures are to move about the aircraft cabin and to carry out the lower limb exercises shown in
airline videos and in-flight magazines.
Any specialised prophylaxis should be targeted at those at the highest risk and include:
It is important to emphasise that the risk of side effects from the use of aspirin outweigh any
potential anti-thrombotic effect and its use is not recommended.
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