optimum platelet count for procedures

Q: Optimum threshold of platelet count for epidural anesthesia is? (select one) 

A) 20,000/microL 

B) 50,000/microL 

C) 80,000/microL

Answer: C

Although it is true that the exact threshold of platelet count can not be predicted for any procedure. Usually, 50,000/microL (50K) is considered an optimum number for more or less most of the procedures. The teaching point of this pearl is to highlight the fact that few procedures may require higher than 50K platelets and vice versa. 

Epidural anesthesia is considered a highly invasive procedure and platelet count should be desired at 80,000/microL. Similarly, neuro or ocular surgeries may even require the threshold of 100,000/microL. In contrast, Central Venous Catheter (central line) can be safely performed when done under ultrasound with a platelet count of 20,000/microL. When it comes to patients with hematologic malignancies and immune thrombocytopenia (ITP), the threshold can be even lower such as at 10,000/microL.

#procedures

#hematology

References:

1. Kumar A, Mhaskar R, Grossman BJ, et al. Platelet transfusion: a systematic review of the clinical evidence. Transfusion 2015; 55:1116. 

2. Zeidler K, Arn K, Senn O, et al. Optimal preprocedural platelet transfusion threshold for central venous catheter insertions in patients with thrombocytopenia. Transfusion 2011; 51:2269. 

3. Vavricka SR, Walter RB, Irani S, et al. Safety of lumbar puncture for adults with acute leukemia and restrictive prophylactic platelet transfusion. Ann Hematol 2003; 82:570. 

4. van Veen JJ, Nokes TJ, Makris M. The risk of spinal haematoma following neuraxial anaesthesia or lumbar puncture in thrombocytopenic individuals. Br J Haematol 2010; 148:15.