“Why can't you get an epidural with low platelets?”
I am a 32 year old female. I want to know why can't you get an epidural with low platelets?
7 Answers
You could develop a hematoma and paraplegia.
It sounds like you had HELLP syndrome. It can cause bleeding and blood collection in the back and could lead to paralysis.
Low platelet count is a relative contraindication to receiving an epidural, particularly for labor pain. The first question the anesthesia provider would want to know is why the platelets are low. Low platelets could cause bleeding which in the epidural space could lead to a neurosurgical emergency to relieve the pressure of an epidural bleed. Since labor epidurals are not mandatory, we look at the risks, benefits, and alternatives to placing one with a low platelet count. Certainly, no one would want to risk having a neurosurgical procedure interfering with
childbirth.
childbirth.
Risk of bleeding Due to low platelets into the spinal canal makes paralysis a possibility.
From Christopher Creighton
From Christopher Creighton
Low platelet counts predispose patients to bleeding near the spinal cord after epidural placement. When bleeding occurs near the spinal cord, the patient complains of a loss of sensation or movement. This loss of sensation or movement could become permanent if it is not rapidly treated. Since local anesthetic medication is administered through the epidural catheter, the medication would mask the signs of bleeding leading to permanent injury.
When the platelet count is low, there is a chance of bleeding during epidural placement of the needle and catheter. The bleeding in the epidural space causes complications including paralysis and sensory loss in the in the lower extremities.
The platelet count may be brought back to normal level with platelet transfusion to make it safe to do epidural anesthesia.
Any medication that works against the platelet function such as acetyl salicylic acid (Aspirin) or clopidogrel (Plavix) has to be discontinued for a week before epidural anesthesia.
The platelet count may be brought back to normal level with platelet transfusion to make it safe to do epidural anesthesia.
Any medication that works against the platelet function such as acetyl salicylic acid (Aspirin) or clopidogrel (Plavix) has to be discontinued for a week before epidural anesthesia.
Increased risk of bleeding when they fall below 100K…and the risk increases as levels decline further. A bleed in the spine is very dangerous and may result in emergency surgery. Some drugs block the ability of blood platelet to work normally. (Aspirin, Plavix, Ibuprofen and many others). I hope this was helpful. Each case must be individualized and this information is just guidelines. See Reg. Anesth. Med. 2018:43: 263-309
