So you have a patient G3P2 30 y/o who had a low platelet count with first pregnancy which prevented an epidural. Zero trouble with current pregnancy and zero further relevant history. Hematology consult after first pregnancy resulted in zero treatment and zero diagnosis according to patient although followed for a year. Almost everyone in our group has a platelet count cut off of 100k although a few will go to 75-80k based on new "emerging evidence". Current OB claims platelets were "normal" a week ago but upon checking lab values they were 81000 3 weeks ago and as of this day they are 79000. This was reported to OB and he subsequently ordered 100mg of solu medrol and recheck platelets in an hour. Patient is 4 cm and situation is explained and she is in agreement having been though this before. After one hour patient is 9 cm and platelets are 77000. Lab decides to do a manual count and it miraculously shows large clumps and platelet count of greater then 240K. Pt. refuses epidural at this point and literally delivers 10 minutes after results are back. Issues that came up during researching this scenario.

1. Do you transfuse platelets just so you can do an Epidural? Some in our group have done it but there are obvious negatives.
A. Risk of transfusion reaction for an elective procedure.
B. What happens after delivery blood loss and you now have to pull catheter with an even lower Platelet count?
C. You have not stopped destruction of platelets so again what happens when time to pull catheter?
D. Waste of a very expensive and valuable resource for an elective procedure.

2. Steroids may be given.
A. OB dropped the ball especially considering history and can't find any supporting evidence for single dose and rapid effect in a little as an hour?

Obviously there are gray areas but as a general rule what is your platelet count cut off for an Epidural? Do you have a lower number for SAB? What are your thoughts on Steroids and Platelet transfusion? What is your cut off for platelet transfusion for GETA and C-section?

Case Studies.

SDN discussion

Thrombocytopenia overview