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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