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.
Highlights
Pregnant women are usually young and healthy, and the expectation is that modern childbirth is relatively safe for mother and baby
Thrombocytopenia caused by Hemolysis, Elevated Liver enzymes and Low Platelet count (HELLP) syndrome in preeclampsia parturients can be associated with substantial maternal and neonatal morbidity
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
Summary
Pregnant women are usually young and healthy, and the expectation is that modern childbirth is relatively safe for mother and baby. A lower limit of 100,000 per microliter for platelet count was suggested as “safe” for performing neuraxial anesthesia, there is no supporting data [3,4]. Guidelines for the use of platelet transfusions [5] recommends that platelet count should be raised to at least 50,000 per microliter for lumbar puncture, and epidural anesthesia. This recommendation was given on the basis of expert opinion and a study of over 5,000 lumbar punctures in children with acute leukemia [6]. We present a case of uneventful spinal anesthesia for urgent cesarean section in a patient with severe preeclamsia, HELLP syndrome and precipitous drop of platelet to 42,000 from 230,000 per microliter
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