Anesthesia in the Pregnant Patient with Hematologic Disorders

Haemostasis and Safety Measures before Lumbar Puncture in the Haematology Ward: The Danish Routines

“…Neither platelet counts nor activated partial thromboplastin times or INR [9] provide information about platelet function. TEG (e.g.…”

“…PFA-100® or Multiplate®) is an alternative bedside assay of coagulation that specifically evaluates platelet function and may be superior in detecting platelet dysfunction in patients with a positive bleeding anamnesis. The information obtained from TEG or PFA could be used in conjunction with usual coagulation tests to determine if adequate coagulation is present before LP [9]. However, no available method has been able to provide high predictive values for bleeding risk [10].…”

“…Thus, performing LP in patients receiving antithrombotic drugs is complex, and the use of para-clinical assessment to predict the risk of bleeding remains a challenge because of the poor predictive value of the current tests [9,10]. …”

Contraindications - Hemorrhage and Coagulopathy, and Patient Refusal

“…Platelets have an important role in continuation of coagulation cascade in the hemostatic system and in formation of hemostatic clumps (Beilin et al, 1997). A low number of platelets impairs surgical hemostasis by increasing the risk of hemorrhage and may cause anesthetic complications such as hematoma (Chow et al, 2011). Patients with ITP should be distinguished from the other causes of thrombocytopenia including sepsis, pregnancy-induced hypertension, disseminated intravascular coagulation, drug-induced thrombocytopenia, thrombocytopenia associated with autoimmune diseases (systemic lupus erythematosus, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, and hereditary forms of thrombocytopenia) (Webert et al, 2003).…”

Postpartum Hemorrhage on Labor and Delivery

“…27 While general anesthesia is preferred for cases with anticipated massive blood loss, a neuraxial catheter can provide analgesia for endovascular sheath placement, may be extended and re-dosed for prolonged surgery, allows the mother to be awake for the delivery, limits fetal exposure to anesthetic, and may decrease blood loss compared with general anesthesia (Supplemental Digital Content 1, http:// links.lww.com/ASA/A130). 10,28,29 The decision between general or neuraxial anesthesia will depend upon the magnitude of anticipated blood loss, the availability of additional anesthesia staff to assist with an unplanned conversion to general anesthesia, and the anticipated risk of a difficult airway. In some cases, elective conversion to general anesthesia just after delivery allows for participation in the birth plus a secure airway for any massive hemorrhage that may follow.…”