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Safety of lumbar puncture for adults with acute leukemia and restrictive prophylactic platelet transfusion

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Abstract

No data exist on the trigger for platelet transfusions in adult thrombocytopenic patients with acute leukemia undergoing lumbar puncture (LP). We reviewed the records of 66 patients with acute leukemia (median age 38 years, range 18–68) who have been treated in our institution for 6 years. A total of 195 LPs were performed. No serious hemorrhagic complications occurred, but there was a significant trend towards a higher percentage of traumatic procedures, defined as the occurrence of >500 erythrocytes per high-power field, in patients with lowest platelet counts (p<0.005). Although not associated with serious clinical bleeding events in this study, the increased occurrence of traumatic procedures may indicate an increased risk for more serious hemorrhagic complications, implying a trigger not lower than 20×109/L for prophylactic transfusions of platelets in adult patients with acute leukemia undergoing LP.

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References

  1. Breuer AC, Tyler HR, Marzewski DJ, Rosenthal DS (1982) Radicular vessels are the most probable source of needle-induced blood in lumbar puncture: significance for the thrombocytopenic cancer patient. Cancer 49:2168–2172

    CAS  PubMed  Google Scholar 

  2. Diem K, Lentner C (eds) (1970) Documenta Geigy Scientific Tables, 7th edn. Ciba-Geigy, Basel

  3. Edelson RN, Chernik NL, Posner JB (1974) Spinal subdural hematomas complicating lumbar puncture. Arch Neurol 31:134–137

    CAS  PubMed  Google Scholar 

  4. Gmur J, Burger J, Schanz U, Fehr J, Schaffner A (1991) Safety of stringent prophylactic platelet transfusion policy for patients with acute leukaemia. Lancet 338:1223–1226

    CAS  PubMed  Google Scholar 

  5. Heckman KD, Weiner GJ, Davis CS, Strauss RG, Jones MP, Burns CP (1997) Randomized study of prophylactic platelet transfusion threshold during induction therapy for adult acute leukemia: 10'000/microL versus 20'000/microL. J Clin Oncol 15:1143–1149

    CAS  PubMed  Google Scholar 

  6. Howard SC, Gajjar A, Ribeiro RC, Rivera GK, Rubnitz JE, Sandlund JT, Harrison PL, de Armendi A, Dahl GV, Pui CH (2000) Safety of lumbar puncture for children with acute lymphoblastic leukemia and thrombocytopenia. J Am Med Assoc 284:2222–2224

    Article  CAS  Google Scholar 

  7. Howard SC, Gajjar AJ, Cheng C, Kritchevsky SB, Somes GW, Harrison PL, Ribeiro RC, Rivera GK, Rubnitz JE, Sandlund JT, de Armendi AJ, Razzouk BI, Pui CH (2002) Risk factors for traumatic and bloody lumbar puncture in children with acute lymphoblastic leukaemia. J Am Med Assoc 288:2001–2007

    Article  Google Scholar 

  8. Rebulla P, Finazzi G, Marangoni F, Ayyisati G, Gugliotta L, Tognoni G, Barbuti T, Mandelli F, Sirchia G (1997) The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. N Engl J Med 337:1870–1875

    Google Scholar 

  9. Ruff RL, Dougherty JH Jr (1981) Complications of lumbar puncture followed by anticoagulation. Stroke 12:879–881

    CAS  PubMed  Google Scholar 

  10. Schiffer CA, Anderson KC, Bennett CL, Elting LS, Goldsmith M, Goldstein M, Hume H, McCullough JJ, McIntryre RE, Powell BL, Rainey JM, Rowley SD, Rebulla P, Troner MB, Wagnon AH (2001) Platelet transfusion for patients with cancer: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 19:1519–1538

    CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Valentin Rousson, PhD, Department of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Switzerland, for help with the statistical analysis.

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Correspondence to Urs Schanz.

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Vavricka, S.R., Walter, R.B., Irani, S. et al. Safety of lumbar puncture for adults with acute leukemia and restrictive prophylactic platelet transfusion. Ann Hematol 82, 570–573 (2003). https://doi.org/10.1007/s00277-003-0707-0

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  • DOI: https://doi.org/10.1007/s00277-003-0707-0

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