Blood disorders

Douglas, M. Joanne; Ballem, Penny

doi:10.1017/cbo9780511544552.018

Cited by 4 publications

(5 citation statements)

References 242 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The minimum platelet count (if reported) in this group was 10 × 10 9 /l. No clear conclusions can be drawn but the reports describing complications are in keeping with suggestions that the safety of epidural anaesthesia in thrombocytopenic patients not only depends on the absolute platelet count, but also on the underlying reason for the thrombocytopenia, how rapidly the platelet count is falling and the presence of a coagulopathy (Douglas & Ballem, 2008; Gill & Kelton, 2000; Kam et al , 2004).…”

Section: Case Reports In Regional Anaesthesiamentioning

confidence: 87%

“…In particular, in patients with idiopathic thrombocytopenic purpura (ITP) with generally good functioning platelets, a level of 50 × 10 9 /l may be sufficient, whereas in patients with HELLP ( h aemolysis, e levated l iver enzymes, l ow p latelet count) syndrome and rapidly falling platelet counts a higher count may be preferable (Douglas, 2001). A more recent publication (Douglas & Ballem, 2008), suggested a minimum level of 40 × 10 9 /l in patients with ITP in whom the risks of general anaesthesia are high. Similarly, Kam et al (2004) also suggested a minimum platelet count of 50 × 10 9 /l for epidural anaesthesia in parturients with ITP and that the entire clinical situation should be taken into account if epidural anaesthesia is considered, including a rapidly falling platelet count.…”

mentioning

confidence: 99%

See 1 more Smart Citation

The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals

2009

View full text Add to dashboard Cite

Summary Neuraxial anaesthesia is increasingly performed in thrombocytopenic patients at the time of delivery of pregnancy. There is a lack of data regarding the optimum platelet count at which spinal procedures can be safely performed. Reports are often confounded by the presence of other risk factors for spinal haematomata, such as anticoagulants, antiplatelet agents and other acquired or congenital coagulopathies/platelet function defects or rapidly falling platelet counts. In the absence of these additional risk factors, a platelet count of 80 × 109/l is a ‘safe’ count for placing an epidural or spinal anaesthetic and 40 × 109/l is a ‘safe’ count for lumbar puncture. It is likely that lower platelet counts may also be safe but there is insufficient published evidence to make recommendations for lower levels at this stage. For patients with platelet counts of 50–80 × 109/l requiring epidural or spinal anaesthesia and patients with a platelet count 20–40 × 109/l requiring a lumbar puncture, an individual decision based on assessment of risks and benefits should be made.

show abstract

Section: Case Reports In Regional Anaesthesiamentioning

confidence: 87%

mentioning

confidence: 99%

The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals

2009

View full text Add to dashboard Cite

show abstract

“…In idiopathic thrombocytopenic purpura and gestational thrombocytopenia, there are reduced platelet numbers, but normal function. In these situations, expert opinion is that an experienced anaesthetist might reasonably perform a neuraxial blockade providing the platelet count is > 50 × 10 9 .l −1 and stable, but an individual risk–benefit assessment should be made . It is possible that spinal anaesthesia with platelet counts below this level may be safe if data are extrapolated from that derived from lumbar punctures in non‐pregnant patients performed by haematologists using needles considerably larger than those used by obstetric anaesthetists .…”

Section: Recommendations Related To Drugs Used To Modify Coagulationmentioning

confidence: 99%

“….l À1 and stable, but an individual risk-benefit assessment should be made [7][8][9][10][11]. It is possible that spinal anaesthesia with platelet counts below this level may be safe if data are extrapolated from that derived from lumbar punctures in non-pregnant patients performed by haematologists using needles considerably larger than those used by obstetric anaesthetists [9].…”

mentioning

confidence: 99%

Regional anaesthesia and patients with abnormalities of coagulation

et al. 2013

View full text Add to dashboard Cite

Summary Concise guidelines are presented that relate abnormalities of coagulation, whether the result of the administration of drugs or that of pathological processes, to the consequent haemorrhagic risks associated with neuraxial and peripheral nerve blocks. The advice presented is based on published guidelines and on the known properties of anticoagulant drugs. Four separate Tables address risks associated with anticoagulant drugs, neuraxial and peripheral nerve blocks, obstetric anaesthesia and special circumstances such as trauma, sepsis and massive transfusion.

show abstract

“…Safe administration of epidural techniques to thrombocytopenic patients depends not only on the absolute platelet number but also on the reason underlying the thrombocytopenia, the rate at which the number of platelets decrease and the presence of a coagulopathy (Douglas & Ballem, 2008;Kam et al, 2004). Presence of coagulopathy contraindicates the use of regional anesthesia.…”

Section: Idiopathic Thrombocytopenic Purpura (Itp)mentioning

confidence: 99%