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How do you evaluate the patient who has a platelet count <100,000 mm−3?
The history and physical examination are key components when deciding whether to proceed with a regional anesthetic in the parturient with thrombocytopenia. If there is any history of easy bruising or the patient has evidence of petechiae or ecchymosis, regional anesthesia should not be offered. If the patient has no bleeding history, it is our prac-tice to obtain at least one additional platelet count as close in time to epidural placement as possible to assure that it not decreasing further. This is especially important in disease processes that are dynamic, such as preeclampsia. We do not obtain any tests of platelet function nor do we have any absolute lower limit for the platelet count. A patient with a stable platelet count of 50,000 mm−3 is probably at lower risk of developing an epidural hematoma than one with a platelet count of 75,000 mm−3 that has been rapidly decreasing.
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