Successful Electroconvulsive Therapy in an Elderly Man with Severe Thrombocytopenia: Case Report and Literature Review

Abstract

Electroconvulsive therapy (ECT) is a safe and effective treatment for depression. Furthermore, modifications to ECT have made it a safe procedure for patients who were previously thought to be too ill or old to undergo the stress of convulsions. Little is known, however, of the safety of performing ECT on patients with severe thrombocytopenia. Such patients may be at increased risk for hemorrhagic complications due to the procedure. In this article, we describe the case of a 74-year-old man with major depression and myelodysplastic syndrome with associated severe thrombocytopenia, who underwent successful administration of a full course (nine treatments) of ECT. The physiologic changes caused by modified ECT and the potential risk of hemorrhage (including intracranial hemorrhage) in thrombocytopenic patients undergoing ECT are also discussed.

Electroconvulsive therapy in the medically Ill

“…This 64-yearold woman had platelet counts between 7 and 38 K/cm 3 . A more recent case report from 2001 demonstrated that a 74-year-old man with severe depression and myelodysplastic syndrome successfully underwent a course of ECT for a total of nine treatments without complication [39]. The patient's platelet count was below 20 K/cm 3 in eight of the treatments, and received pretreatment transfusions of platelets before each treatment.…”

Oesophageal carcinoma and refractory idiopathic thrombocytopenic purpura

“…For the same reasons, insertion of a palliative oesophageal stent was not possible. There are only a few reports in the literature that deal with invasive procedures in severely thrombocytopenic patients [9,10], and in general a platelet count around 50 3 10 9 /l is recommended. In a series from New York, uncorrectable coagulopathy was cited as an absolute contraindication to PEG insertion [11].…”