RESUMEN
We report the case of a normotensive 31-year-old parturient who received combined spinal-epidural analgesia for early labor, and who was then found to have an unexpectedly low platelet count (25â¯000/µL) with elevated liver enzymes, but without alterations in blood pressure.
Asunto(s)
Anestesia Epidural , Anestesia Obstétrica , Síndrome HELLP/diagnóstico , Trabajo de Parto , Trombocitopenia/complicaciones , Adulto , Femenino , Humanos , EmbarazoRESUMEN
BACKGROUND: Laboring women with low platelet counts may be denied neuraxial block due to concerns about causing a spinal-epidural hematoma. AIMS: To assess the anesthetic management, complications and outcome variables of women with low platelet counts, and to expand the existing data regarding the safety of neuraxial blocks in this patient population. METHODS: This is a retrospective analysis of anesthetic and obstetric data from women with platelet countsâ¯<100â¯000/µL, who were admitted to a single referral center during 2011-2014. The rate of neuraxial block and related complications were examined in relation to the platelet count and the results combined with published data to assess the risk of spinal-epidural hematoma. RESULTS: During the study period, 471 of 45â¯462 women (1%) had a low platelet count (<100â¯000/µL). The rate of neuraxial block was significantly higher in women with platelet counts of 70-99â¯000/µL (280/394, 71.1%) when compared to women with platelet counts of 50-69â¯000/µL and 0 to 49â¯000/µL (23/59, 38.9% and 5/18, 27.8%, respectively, Pâ¯<0.0001). Women in the lower platelet count ranges had a higher risk of cesarean delivery under general anesthesia and longer hospital stay. No neuraxial hematoma were reported. CONCLUSIONS: This study contributes a substantial series of neuraxial blocks among women with low platelet counts. The findings support that the risk of hematoma is low if the platelet count is <100â¯000/µL, specifically between 70 and 99â¯000/µL. Risk assessment in the lower count ranges requires a much larger sample.