Thrombocytopenia and Neuraxial Anesthesia?

[secoy]

Hey guys:

New private attending here. Just wanted some input on how other departments manage parturients with thrombocytopenia.

What are the acceptable lower limits for platelets prior to epidural/spinal placement at your hospital?

Do you recheck the platelet count prior to discontinuing the epidural?

Also, is there a system in place where by parturients who develop gestational thrombocytopenia are seen by hematology prior to their deliveries?

Currently, our department has no policy in regards to managing these patients. I personally use a 70,000 platelet minimum as my cut off. Although, I believe recent literature suggests using 50,000 platelets as an acceptable cutoff.
Also I consider the trend of the platelet count, and may be less hesitant to place an epi in a pt whose platelet count is dropping rapidly. We currently have no system in place to determine which patients, if any, need a hematology consult.

I would be interested in hearing how things are done at your hospitals.

Thanks,
Secoy

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[pgg]

There was a thread here covering some of these issues a few months ago - http://forums.studentdoctor.net/showthread.php?t=663595


My personal answers to your three bolded questions -

1) I have no rigid limit, but generally 75K, maybe as low as 50K for the right patient.

2) Yes, if placing the epidural in the first place was a borderline decision.

3) Not routinely. Hematology consults would be considered for people with known or suspected disorders. Just benign gestational thrombocytopenia - no.

 

[IlDestriero]

Elective labor epidural -- 100K

Spinal for Csection- I've done as low as 70K. Would go a little lower for the right patient. e.g. difficult airway

I would and have placed an epidural with 75K and a spinal for anything over 50K. I don't know of any really good literature either way, but there are case reports of spinals with platelets as low as the teens w/o complications.