Pre-Eclampsia and platelets

[Beeftenderloin]

Patient comes in for induction of labor for pre-eclampsia without severe features. They get a CBC on arrival. Platelets are 300. How long is that number valid for you for neuraxial placement? What’s your cut off time for needing a repeat draw? What if pre-E with severe features? There’s no institutional policy at my place, just provider discretion. Just trying to get a feel for what others are doing.

 

[Mman]

we will usually get a platelet count every 24 hours throughout admission and if the patient requests epidural the nurse will call the anesthesiologist and ask if they want another prior to placement

 

[T-burglar]

See if you can find anything in the literature about the time course of thrombocytopenia in preeclampsia. If you can’t find anything informative there then I would suggest you document that the patient has no symptoms of signs of coagulopathy (check their mucus membranes, skin in dependent areas, etc.)

 

[DrZzZz]

Our policy is platelet level within 6 hours of both placement and removal of a catheter if there's a history of Pre-E, regardless of symptoms/features. Maybe on the conservative side, but for a totally elective procedure, I'm ok with that.

 

[sigrhoillusion]

Our policy is platelet level within 6 hours of both placement and removal of a catheter if there's a history of Pre-E, regardless of symptoms/features. Maybe on the conservative side, but for a totally elective procedure, I'm ok with that.

Wait... epidurals are elective procedures? 🤔

 

[DrZzZz]

Wait... epidurals are elective procedures? 🤔

Don't let the L&D nurses in on the secret!

 

[Volatile]

Where I trained they wanted a plt count within 8hrs for a patient with pre-e. I’m slightly less conservative in my current practice but depends on plt trends