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Habas E, Rayani A, Alfitori G, Eldin Ahmed G, Elzouki ANY. Gestational Thrombocytopenia: A Review on Recent Updates. Cureus 2022; 14:e23204. [PMID: 35444886 PMCID: PMC9010930 DOI: 10.7759/cureus.23204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/08/2022] Open
Abstract
Thrombocytopenia is a condition in which the blood platelet count is low. It is well established that the mild thrombocytopenia frequency is higher in normal pregnancy. This type of thrombocytopenia was named pregnancy-induced thrombocytopenia. However, recently, it has been widely known as gestational thrombocytopenia (GT). The rate is higher in women with a prior GT history and multiple pregnancies. However, it appears that GT is a physiological response to the pregnancy; placenta's peculiar structure and its unique blood flow pattern play major roles in GT development. There are no specific, precise, or known underlying pathophysiological mechanisms of GT, and no new specific management strategies are published yet. Therefore, we decided to do a non-systematic review of any recent updates that had been published in PubMed, EMBASE, and Web of Science about the pathophysiology of GT, its treatment, and other related topics.
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Peterson W, Tse B, Martin R, Fralick M, Sholzberg M. Evaluating hemostatic thresholds for neuraxial anesthesia in adults with hemorrhagic disorders and tendencies: A scoping review. Res Pract Thromb Haemost 2021; 5:e12491. [PMID: 33977207 PMCID: PMC8105160 DOI: 10.1002/rth2.12491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 12/29/2020] [Accepted: 01/01/2021] [Indexed: 11/08/2022] Open
Abstract
Neuraxial anesthesia can be complicated by spinal or epidural hematoma and may result in permanent neurologic injury. There is a paucity of literature characterizing this serious complication in patients with congenital and acquired hemorrhagic disorders or tendencies. The objective of this scoping review was to describe the hemostatic laboratory parameters where neuraxial anesthesia has been administered with and without spinal and epidural hematoma in patients with preexisting hemorrhagic disorders and tendencies, including immune thrombocytopenia, gestational thrombocytopenia, thrombocytopenia associated with hypertensive disorders of pregnancy, platelet function disorders, von Willebrand disease, coagulation factor deficiencies, and fibrinogen disorders. A systematic search of Ovid MEDLINE, CINAHL, Embase, Scopus, and Web of Science was performed. Two authors independently reviewed all titles, abstracts, and full texts to determine study eligibility and extract data. Qualitative synthesis of 91 studies revealed significant gaps in our understanding of the risk of spinal and epidural hematoma in patients with hemorrhagic disorders and tendencies, including few studies of males and in nonobstetric settings. Most reviewed articles were small, retrospective studies at high risk for potential bias. With such low-quality data, we were unable to provide any true estimates of the risk of spinal or epidural hematoma for these patients, nor could we attribute any specific hemostatic or laboratory values to increased risk of hematoma. There is a need both for larger and more rigorously designed and reported studies on this subject and for structured, comprehensive recommendations for safe administration and removal of neuraxial anesthesia in patients with hemorrhagic disorders and tendencies.
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Affiliation(s)
- Wynn Peterson
- Division of Medicine University of Toronto Toronto ON Canada
| | - Brandon Tse
- Faculty of Medicine University of Toronto Toronto ON Canada
| | - Rachel Martin
- Department of Anesthesia St. Michael's Hospital Toronto ON Canada
| | - Michael Fralick
- Sinai Health System and the Department of Medicine University of Toronto Toronto ON Canada
| | - Michelle Sholzberg
- Division of Hematology Department of Medicine and Department of Laboratory Medicine and Pathobiology St. Michael's Hospital Toronto ON Canada
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Malinowski AK, Othman M. Obstetric neuraxial anaesthesia in the setting of immune thrombocytopenia and low platelet counts: call to participate in an international registry. Br J Anaesth 2021; 127:e12-e13. [PMID: 33926714 DOI: 10.1016/j.bja.2021.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/01/2021] [Accepted: 03/11/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ann Kinga Malinowski
- Department of Obstetrics & Gynaecology, Division of Maternal-Fetal Medicine, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada; Department of Obstetrics & Gynaecology, University of Toronto, ON, Canada.
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, ON, Canada; School of Baccalaureate Nursing, St. Lawrence College, Kingston, ON, Canada
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Beilin Y, Katz DJ. Analgesia use among 984 women with preeclampsia: A retrospective observational single-center study. J Clin Anesth 2020; 62:109741. [DOI: 10.1016/j.jclinane.2020.109741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/30/2019] [Accepted: 02/08/2020] [Indexed: 11/25/2022]
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Bailey LJ, Shehata N, De France B, Carvalho JCA, Malinowski AK. Obstetric neuraxial anesthesia at low platelet counts in the context of immune thrombocytopenia: a systematic review and meta-analysis. Can J Anaesth 2019; 66:1396-1414. [DOI: 10.1007/s12630-019-01420-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 02/08/2023] Open
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Ho AMH, Mizubuti GB, Ho AK. Safety of spinal anesthesia in thrombocytopenic patients: are there lessons to be learnt from oncology? Reg Anesth Pain Med 2019; 44:29-31. [DOI: 10.1136/rapm-2018-000011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/22/2018] [Accepted: 05/23/2018] [Indexed: 12/28/2022]
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Neuraxial block for delivery among women with low platelet counts: a retrospective analysis. Int J Obstet Anesth 2018; 35:4-9. [DOI: 10.1016/j.ijoa.2018.01.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/07/2018] [Accepted: 01/17/2018] [Indexed: 02/08/2023]
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Riveros-Perez E, Hermesch AC, Barbour LA, Hawkins JL. Aplastic anemia during pregnancy: a review of obstetric and anesthetic considerations. Int J Womens Health 2018; 10:117-125. [PMID: 29535558 PMCID: PMC5836687 DOI: 10.2147/ijwh.s149683] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aplastic anemia is a hematologic condition occasionally presenting during pregnancy. This pathological process is associated with significant maternal and neonatal morbidity and mortality. Obstetric and anesthetic management is challenging, and treatment requires a coordinated effort by an interdisciplinary team, in order to provide safe care to these patients. In this review, we describe the current state of the literature as it applies to the complexity of aplastic anemia in pregnancy, focusing on pathophysiologic aspects of the disease in pregnancy, as well as relevant obstetric and anesthetic considerations necessary to treat this challenging problem. A multidisciplinary-team approach to the management of aplastic anemia in pregnancy is necessary to coordinate prenatal care, optimize maternofetal outcomes, and plan peripartum interventions. Conservative transfusion management is critical to prevent alloimmunization. Although a safe threshold-platelet count for neuraxial anesthesia has not been established, selection of anesthetic technique must be evaluated on a case-to-case basis.
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Affiliation(s)
- Efrain Riveros-Perez
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | | | | | - Joy L Hawkins
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
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Ozelo MC, Colella MP, de Paula EV, do Nascimento ACKV, Villaça PR, Bernardo WM. Guideline on immune thrombocytopenia in adults: Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Project guidelines: Associação Médica Brasileira - 2018. Hematol Transfus Cell Ther 2018; 40:50-74. [PMID: 30057974 PMCID: PMC6001928 DOI: 10.1016/j.htct.2017.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 02/07/2023] Open
Affiliation(s)
| | | | | | | | - Paula Ribeiro Villaça
- Universidade de São Paulo, Faculdade de Medicina Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Wanderley Marques Bernardo
- Universidade de São Paulo, Faculdade de Medicina Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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Nkomentaba L, Bishop DG, Rodseth RN. Preoperative predictors of thrombocytopenia in Caesarean delivery: is routine platelet count testing necessary? SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2017. [DOI: 10.1080/22201181.2017.1397877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Lulama Nkomentaba
- Nelson R. Mandela School of Medicine, Discipline of Anaesthesia and Critical Care, University of KwaZulu-Natal, Durban, South Africa
| | - David G Bishop
- Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Reitze N Rodseth
- Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, KwaZulu-Natal, Pietermaritzburg, South Africa
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
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Riveros-Perez E, Hermesch A, Barbour L, Hawkins J. Aplastic anemia in two consecutive pregnancies: obstetric and anesthetic management. Int J Obstet Anesth 2017; 33:71-75. [PMID: 29108725 DOI: 10.1016/j.ijoa.2017.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
Aplastic anemia is a serious condition occasionally coexisting with pregnancy. This pathological process is associated with significant maternal and neonatal morbidity and mortality. Obstetric and anesthetic management are particularly challenging, and treatment requires knowledge of pathophysiologic mechanisms in order to provide safe care to this group of patients. We describe the successful obstetric management and labor analgesia of a patient with a diagnosis of aplastic anemia in two consecutive pregnancies.
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Affiliation(s)
- E Riveros-Perez
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, United States.
| | - A Hermesch
- Maternal Fetal Medicine, University of Colorado School of Medicine, United States
| | - L Barbour
- Medicine and Obstetrics and Gynecology, University of Colorado School of Medicine, United States
| | - J Hawkins
- Department of Anesthesiology, Director of Obstetric Anesthesia, University of Colorado School of Medicine, United States
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Malinowski A, De France B, Sun D, Carvalho JCA, Shehata N. Obstetric neuraxial anaesthesia in the context of maternal immune thrombocytopenia: secondary analysis of a retrospective cohort study. Br J Anaesth 2017; 119:1067-1068. [DOI: 10.1093/bja/aex335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Risk of Epidural Hematoma after Neuraxial Techniques in Thrombocytopenic Parturients: A Report from the Multicenter Perioperative Outcomes Group. Anesthesiology 2017; 126:1053-1063. [PMID: 28383323 DOI: 10.1097/aln.0000000000001630] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Thrombocytopenia has been considered a relative or even absolute contraindication to neuraxial techniques due to the risk of epidural hematoma. There is limited literature to estimate the risk of epidural hematoma in thrombocytopenic parturients. The authors reviewed a large perioperative database and performed a systematic review to further define the risk of epidural hematoma requiring surgical decompression in this population. METHODS The authors performed a retrospective cohort study using the Multicenter Perioperative Outcomes Group database to identify thrombocytopenic parturients who received a neuraxial technique and to estimate the risk of epidural hematoma. Patients were stratified by platelet count, and those requiring surgical decompression were identified. A systematic review was performed, and risk estimates were combined with those from the existing literature. RESULTS A total of 573 parturients with a platelet count less than 100,000 mm who received a neuraxial technique across 14 institutions were identified in the Multicenter Perioperative Outcomes Group database, and a total of 1,524 parturients were identified after combining the data from the systematic review. No cases of epidural hematoma requiring surgical decompression were observed. The upper bound of the 95% CI for the risk of epidural hematoma for a platelet count of 0 to 49,000 mm is 11%, for 50,000 to 69,000 mm is 3%, and for 70,000 to 100,000 mm is 0.2%. CONCLUSIONS The number of thrombocytopenic parturients in the literature who received neuraxial techniques without complication has been significantly increased. The risk of epidural hematoma associated with neuraxial techniques in parturients at a platelet count less than 70,000 mm remains poorly defined due to limited observations.
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López Correa T, Sastre Rincón JA. Caesarean section in a patient with chronic portal vein thrombosis and thrombocytopenia: Case report. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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López Correa T, Sastre Rincón JA. Cesárea en paciente con trombosis portal crónica y trombocitopenia: reporte de caso. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Caesarean section in a patient with chronic portal vein thrombosis and thrombocytopenia: Case report☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201707000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Forest DJ, Segal S. Update on Thrombocytopenia in Pregnancy and Neuraxial Anesthesia. CURRENT ANESTHESIOLOGY REPORTS 2017. [DOI: 10.1007/s40140-017-0204-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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De Robertis E, Borrelli V, Anfora R, Scibelli G, Piazza O, Romano GM. Choosing wisely in obstetric anesthesia: Reexamining our practice. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2016. [DOI: 10.1016/j.tacc.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Başaran B, Çelebioğlu B, Başaran A, Altınel S, Kutlucan L, Martin JN. Anesthetic practices for patients with preeclampsia or HELLP syndrome: A survey. J Turk Ger Gynecol Assoc 2016; 17:128-33. [PMID: 27651719 DOI: 10.5152/jtgga.2016.16094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/20/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Substantial controversy exists regarding anesthetic management for patients with preeclampsia or hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome. Experts, researchers, clinicians, and residents in Turkey were surveyed about their practices. MATERIAL AND METHODS Questionnaires were distributed to attendees at a national conference, and they were filled out immediately. Anonymous 10-item paper surveys were administered to both residents and non-residents. Descriptive statistics were used in the analysis. Agreement among ≥75% of the respondents was considered a majority opinion. Surveys with missing responses were used to analyze the non-response bias. The Chi-square test was used for comparisons. A historical cohort of obstetricians-gynecologists was used for comparison with anesthesiologists. RESULTS Of 339 surveys distributed, 288 were returned (84.9% response rate). Among the returned surveys, the completion rate was 96.1%. The job experience in years among clinicians and residents was 9±5 and 3±1, respectively. General anesthesia was still significantly preferred by 36.1% among patients with preeclampsia with platelet counts of ≥100,000/μL. Compared to obstetricians-gynecologists, anesthesiologists more often preferred general anesthesia. With platelet counts of <50,000/μL or eclampsia, most respondents preferred general anesthesia 94.4% for very low platelets and 89.5% for eclampsia. CONCLUSION A preferential trend toward general anesthesia for patients with preeclampsia or HELLP syndrome exists among anesthesiologists in Turkey, particularly for patients with severe thrombocytopenia and/or eclampsia. There exists a need for well-designed and well-executed prospective clinical trials to provide evidence for the best consensus practice.
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Affiliation(s)
- Betül Başaran
- Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey
| | - Bilge Çelebioğlu
- Department of Anesthesiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ahmet Başaran
- Department of Obstetrics and Gynecology, Konya Training and Research Hospital, Konya, Turkey
| | - Seher Altınel
- Department of Anesthesiology, Ankara Gazi Mustafa Kemal State Hospital, Ankara, Turkey
| | - Leyla Kutlucan
- Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey
| | - James N Martin
- Department of Obstetrics and Gynecology, The University of Mississippi Medical Center, Jackson, USA
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Bernstein J, Hua B, Kahana M, Shaparin N, Yu S, Davila-Velazquez J. Neuraxial Anesthesia in Parturients with Low Platelet Counts. Anesth Analg 2016; 123:165-7. [DOI: 10.1213/ane.0000000000001312] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Goodier CG, Lu JT, Hebbar L, Segal BS, Goetzl L. Neuraxial Anesthesia in Parturients with Thrombocytopenia: A Multisite Retrospective Cohort Study. Anesth Analg 2015; 121:988-991. [PMID: 26378701 DOI: 10.1213/ane.0000000000000882] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The primary aim of this study was to estimate the risk of neuraxial hematoma associated with neuraxial anesthetic procedures in thrombocytopenic parturients. METHODS A multicenter retrospective cohort study design was used to estimate the risk for spinal-epidural hematoma in parturients with a platelet count of <100,000/mm receiving neuraxial anesthesia and the risk of complications in thrombocytopenic parturients who receive general anesthesia. RESULTS No cases of spinal hematoma were observed in 102 thrombocytopenic parturients receiving epidural analgesia or 71 receiving spinal anesthesia. Including data from the previous published series (total n = 499), the exact binomial 95% confidence interval for the risk of spinal-epidural hematoma was 0% to 0.6%. Given the small number of patients at each specific platelet count, the theoretical risks at individual platelet count strata are presented. Overall aggregate serious morbidity rate in women who received general anesthesia secondary to thrombocytopenia was 6.5% (95% confidence interval, 2.1%-14.5%). CONCLUSIONS Our work supports the relative maternal safety of neuraxial anesthesia in parturients with mild thrombocytopenia and estimates the maternal complication rate associated with the avoidance of neuraxial anesthesia. Remaining uncertainties at lower platelet counts make a national "low platelet" registry critical to a more accurate assessment of the risk of epidural hematoma and would aid in standardization of anesthesia practice.
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Affiliation(s)
- Christopher G Goodier
- From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Medical University of South Carolina, Charleston, South Carolina; Department of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts; Department of Anesthesia, Medical University of South Carolina, Charleston, South Carolina; Department of Anesthesiology, Tufts University Medical Center, Boston, Massachusetts; and Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Temple University and Shriners Hospital Pediatric Research Center, Philadelphia, Pennsylvania
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Foerster MV, Pedrosa FDPR, da Fonseca TCT, Couceiro TCDM, Lima LC. Lumbar punctures in thrombocytopenic children with cancer. Paediatr Anaesth 2015; 25:206-10. [PMID: 25331026 DOI: 10.1111/pan.12527] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Lumbar punctures (LP) in patients presenting thrombocytopenia are linked to the possibility of bleeding and spinal hematomas. The minimum platelet count required for the safe performance of spinal procedures is still under discussion. Children with some oncology diseases require routinely lumbar punctures; such patients often present thrombocytopenia, making this group an ideal population to study the association between lumbar puncture in thrombocytopenic patients and complications. OBJECTIVES To determine the platelet count of oncology children undergone lumbar punctures and the occurrence of spinal hematomas. METHOD Observational longitudinal study. It included a retrospective analysis of electronic medical records of oncology patients submitted to LP for intrathecal chemotherapy between January 2004 and October 2011, carried out at the 'Instituto de Medicina Integral Prof. Fernando Figueira (IMIP)', Recife, Brazil. RESULTS We evaluated 9088 lumbar punctures performed in 440 patients. The platelet count distribution before lumbar punctures was as follows: 25 punctures had zero to 10,000 platelets per mm(3), 67 punctures had between 10,000 and 20,000 platelets per mm(3), 88 had between 20,000 and 30,000 platelets per mm(3), 92 punctures had between 30,000 and 40,000 platelets per mm(3), 107 punctures had between 40,000 and 50,000 platelets per mm(3), and 729 punctures had between 50,000 and 100,000 platelets per mm(3). In this series, the incidence of bloody tap was 16.9% (1112 lumbar punctures of 6552 had more than ten erythrocytes). No complications were observed. CONCLUSIONS Even in thrombocytopenic patient, an epidural hematoma would be a relatively rare complication following lumbar puncture. Despite the large number of punctures performed on patients with platelet counts below 100,000 mm(-3) (n = 1108), further studies are necessary in order to determine a lower safe platelet count threshold for the performance of lumbar punctures in healthy patients undergoing neuraxial anesthesia.
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Affiliation(s)
- Mirella V Foerster
- Anesthesiology, Oncology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil
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Kim G, Sim H, Yang J, Lee JH, Choi DH. Combined spinal-epidural anesthesia in a mild thrombocytopenic patient with antiphospholipid antibody syndrome. Korean J Anesthesiol 2015; 67:S100-1. [PMID: 25598873 PMCID: PMC4295947 DOI: 10.4097/kjae.2014.67.s.s100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Gahyun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunyee Sim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaeyoung Yang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duck Hwan Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Heitz C, Lorette A, Julian A, Roubaud C, Paquet C. Enquête d’opinions sur la pratique de la ponction lombaire non urgente chez des patients à risque hémorragiques/thrombotiques. Rev Neurol (Paris) 2014; 170:685-92. [DOI: 10.1016/j.neurol.2014.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/08/2014] [Accepted: 05/28/2014] [Indexed: 10/24/2022]
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