Patients with thrombocytopenia may require lumbar puncture or epidural anesthesia, but the appropriate threshold for platelet transfusions in this context remains unclear, according to a study published in the Cochrane Database of Systematic Reviews.
In the United States, the platelet count threshold for administering transfusions to a patient prior to a lumbar puncture is 50 x 109 L; this threshold varies worldwide. If this threshold is higher than necessary, patients may face excess exposure to transfusion-related risks.
In this study, which was a follow-up to a 2016 Cochrane Review, the authors intended to evaluate data from multiple study designs regarding platelet transfusions for lumbar punctures or epidural catheterization in patients with thrombocytopenia. However, after reviewing several databases for relevant studies, the authors identified only 3 retrospective cohort studies. All 3 were specific to patients undergoing lumbar punctures and did not compare platelet count thresholds.
Primary outcomes were major bleeding within 24 hours of a procedure, all-cause mortality within 30 days following a procedure, and serious adverse events. The studies varied regarding which outcomes were reported.
Only 2 studies, 1 involving children (129 patients) and 1 involving adults (21 patients), reported outcomes with or without platelet transfusion. In total, 57 children and 14 adults had received platelet transfusions.
All-cause mortality within 30 days was not assessed in the identified studies. There was no reported procedure-related major bleeding, and minor bleeding risk did not significantly differ between patients who had and had not received platelet transfusions. Only the study involving adults discussed adverse events, and no serious procedure-related adverse events were reported.
The authors highlighted the lack of controlled trials that might offer guidance on platelet transfusions in patients undergoing lumbar punctures or epidural procedures. In addition, they noted that “[detecting] a doubling in the number of participants with major bleeding from 0.1% to 0.2% would require a study with more than 47,000 participants” and instead recommended using electronic medical records to obtain information regarding platelet transfusion thresholds.
- Estcourt LJ, Malouf R, Hopewell S, Doree C, Van Veen J. Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia [published online April 30, 2018]. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD011980.pub3