Pt referred to clinic from neurosurgeon for ESI. 90 yo M w virgin back, h/o CLBP MRI L5/S1 DDD, spondylosis L5 radic and concordant symptoms. States he has had an ESI a year ago from neurosurgeon w relief. Has h/o myelodysplasia with plts from 45K-48K. Wants ESI done. I haven't dealt w myelodysplasia since 3rd year of medical school, so I'm not really sure here. What to do?