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Uneventful Spinal Anesthesia in a Patient with Precipitous Drop of Platelet Secondary to HELLP Syndrome: A Case Report and Review of Literatures

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DOI: 10.4236/ojanes.2012.24031    6,043 Downloads   10,012 Views   Citations

ABSTRACT

Thrombocytopenia caused by Hemolysis, Elevated Liver enzymes and Low Platelet count (HELLP) syndrome in pre-eclampsia parturients can be associated with substantial maternal and neonatal morbidity. Data on the issue of the safety of neuraxial anesthesia with thrombocytopenia in HELLP syndrome is limited. A lower limit of 100,000 per microliter for platelet count was suggested as “safe” for performing neuraxial anesthesia, however there is no supporting data. This lower limit is challenged lately. We present a case of uneventful spinal anesthesia for urgent Cesarean section in a patient with severe pre-eclamsia, HELLP syndrome and precipitous platelet drop from 230,000 to 42,000 per microliter.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

J. Liu, C. Li and H. Wang, "Uneventful Spinal Anesthesia in a Patient with Precipitous Drop of Platelet Secondary to HELLP Syndrome: A Case Report and Review of Literatures," Open Journal of Anesthesiology, Vol. 2 No. 4, 2012, pp. 138-141. doi: 10.4236/ojanes.2012.24031.

References

[1] W. Ruppen, S. Derry, H. McQuay and R. A. Moore, “Incidence of Epidural Hematoma, Infection, and Neurologic Injury in Obstetric Patients with Epidural Analgesia/Anesthesia,” Anesthesiology, Vol. 105, No. 2, 2006, pp. 394399. doi:10.1097/00000542-200608000-00023
[2] T. Horlocker, D. J. Wedel, J. C. Rowlingson, et al., “Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines,” Regional Anesthesia and Pain Medicine, Vol. 35, No. 1, 2010, pp. 64-101. doi:10.1097/AAP.0b013e3181c15c70
[3] Bromage, “Neurologic Complications of Regional Anaesthesia for Obstetrics,” 3rd Edition, Williams &Wilkins, 1993.
[4] S. H. Rolbin and E. Musclow, et al., “Epidural Anesthesia in Pregnant Patients with Low Platelet Counts,” Obstetrics & Gynecology, Vol. 71, No. 6, 1988, pp. 918-920.
[5] British Committee for Standards in Haematology, “Guidelines for the Use of Platelet Transfusions,” British Journal of Haematology, Vol. 122, No. 1, 2003, pp. 10-23. doi:10.1046/j.1365-2141.2003.04468.x
[6] S. Howard, A. Gajjar, R. C. Ribeiro, et al., “Safety of Lumbar Puncture for Children with Acute Lymphoblasticleukemia and Thrombocytopenia,” Journal of the American Medical Association, Vol. 284, No. 17, 2000, pp. 22222224. doi:10.1001/jama.284.17.2222
[7] J. van Veen, T. J. Nokes and M. Makris, “The Risk of Spinal Haematoma Following Neuraxial Anaes-Thesia or Lumbar Puncture in Thrombocytopenic Individuals,” British Journal of Haematology, Vol. 148, No. 1, 2010, pp. 15-25. doi:10.1111/j.1365-2141.2009.07899.x
[8] P. Hew-Wing, S. H. Rolbin, E. Hew, et al., “Epidural Anaesthesia and Thrombocytopenia,” Anaesthesia, Vol. 44, No. 9, 1989, pp. 775-777. doi:10.1111/j.1365-2044.1989.tb09270.x
[9] Y. Beilin, J. Zahn and M. Comerford, “Safe Epidural Analgesia in Thirty Parturients with Platelet Counts between 69,000 and 98,000 mm?3,” Anesthesia and Analgesia, Vol. 85, No. 2, 1997, pp. 385-390.
[10] S. Choi and R. Brull, “Neuraxial Techniques in Obstetric and Non-Obstetric Patients with Common Bleeding Diatheses,” Anesthesia and Analgesia, Vol. 109, No. 2, 2009, pp. 648-660. doi:10.1213/ane.0b013e3181ac13d1
[11] K. T. Rasmus, R. L. Kotelko, et al., “Unrecognized Thrombocytopenia and Regional Anesthesia in Parturients: A Retrospective Review,” Obstetrics & Gynecology, Vol. 73, No. 6, 1989, pp. 943-946.
[12] C. A. Schiffer, K. C. Anderson, C. L. Bennett, et al., “Platelet Transfusion for Patients with Cancer: Clinical Practice Guidelines of the American Society of Clinical Oncology,” Journal of Clinical Oncology, Vol. 19, No. 5, 2001, pp. 1519-1538.
[13] K. McCrae, P. Samuels and A. D. Schreiber, “Pregnancy Associated Thrombocytopenia: Patho-Genesis and Management,” Blood, Vol. 80, No. 11, 1992, pp. 2697-2714.
[14] P. Kam, S. A. Thompson and A. C. S. Liew, “Thrombocytopenia in the Parturient,” Anaesthesia, Vol. 59, No. 3, 2004, pp. 255-264. doi:10.1111/j.1365-2044.2004.03576.x
[15] B. M. Sibai, “The HELLP Syndrome (Hemolysis, Elevated Liver Enzymes and Low Platelets). Much Ado about Nothing?” American Journal of Obstetrics and Gynecology, Vol. 162, No. 2, 1990, pp. 311-316.
[16] S. Palit, G. Palit, M. Vercauteren and Y. Jacquemyn, “Regional Anaesthesia for Primary Caesarean Section in Patients with Preterm HELLP Syndrome: A Review of 102 Cases,” Clinical & Experimental Obstetrics & Gynecology, Vol. 36, No. 4, 2009, pp. 230-234.
[17] W. Roberts, K. G. Perry Jr., J. B. Woods, et al., “The Intrapartum Platelet Count in Patients with HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelets) Syndrome: Is It Predictive of Later Hemorrhagic Complications?” American Journal of Obstetrics & Gynecology, Vol. 171, No. 3, 1994, pp. 799-804.
[18] British Committee for Standards in Haematology, “Transfusion Guidelines for Neonates and Older Children,” British Journal of Haematology, Vol. 124, No. 4, 2004, pp. 433-453. doi:10.1111/j.1365-2141.2004.04815.x
[19] V. Frenk, V. Camann and K. B. Shankar, “Regional Anesthesia in Parturients with Low Platelet Counts,” Canadian Journal of Anesthesia, Vol. 52, No. 1, 2005. p. 114. doi:10.1007/BF03018594

  
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