Anesthetic Management of the Syndrome of Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) in Severe Preeclampsia

Ramanathan, Jaya; Khalil, M. I.; Sibai, Bahaeddine M; Chauhan, Dinesh

doi:10.1097/00132582-198810000-00004

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“…Twelve studies involved no platelet transfusions (Beilin 1997; Bernstein 2016; Foerster 2015; McLure 2003; Noris 2014; Palit 2008; Ramanathan 1988; Rolbin 1988; Ruell 2006; Totadri 2014; Waldman 1987; Welter 2008).…”

Section: Resultsmentioning

confidence: 99%

Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia

Estcourt

Malouf

Hopewell

et al. 2018

Cochrane Database of Systematic Reviews

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We found no evidence from RCTs or non-randomised studies on which to base an assessment of the correct platelet transfusion threshold prior to insertion of a lumbar puncture needle or epidural catheter. There are no ongoing registered RCTs assessing the effects of different platelet transfusion thresholds prior to the insertion of a lumbar puncture or epidural anaesthesia in people with thrombocytopenia. Any future study would need to be very large to detect a difference in the risk of bleeding. A study would need to be designed with at least 47,030 participants to be able to detect an increase in the number of people who had major procedure-related bleeding from 1 in 1000 to 2 in 1000. The use of a central data collection register or routinely collected electronic records (big data) is likely to be the only method to systematically gather data relevant to this population.

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