The risk of lumbar puncture (LP) hemorrhagic complications is believed to be exacerbated by thrombocytopenia, yet evaluations in clinical practice are lacking. We conducted a retrospective cohort study to examine the risk of traumatic tap (TT) and significant hemorrhagic complications in thrombocytopenic patients undergoing bedside LP. Two hundred sixty-two adult patients undergoing initial bedside LP were analyzed. Overall, we observed 37 TTs (14.1%, 95% CI 10.0 to 18.3%). TTs occurred in 11 of 78 LPs performed on patients with thrombocytopenia, compared with 26 of 184 LPs among patients with a normal platelet count (14.1% vs 14.1%; p > 0.99) and 6 of 19 LPs among patients with severe thrombocytopenia compared with 31 of 243 among those without (31.6% vs 12.8%; p = 0.04). For patients with severe thrombocytopenia, the relative risk of TT was 2.5 (95% CI 1.2 to 5.2; p = 0.02). Stratifying this group by operator experience, a higher incidence of TTs was observed in LPs performed by trainees (57.1% vs 15.8%; p = 0.02), an effect which did not reach significance in LPs performed by dedicated procedural operators (16.7% vs 10.8%; p = 0.63). The presence of other bleeding risk factors was not found to be statistically associated with the incidence of TT. There were no significant hemorrhagic complications. TTs occurred significantly more frequently among patients with severe thrombocytopenia, an effect modulated by operator experience. For patients in this higher risk group, LPs should be performed by the most skilled operators available.
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Peltola J, Sumelahti ML, Kumpulainen T, Dastidar P, Helen P (1996) Spinal epidural haematoma complicating diagnostic lumbar puncture. Lancet. 347(8994):131
Hart IK, Bone I, Hadley DM (1988) Development of neurological problems after lumbar puncture. Br Med J (Clin Res Ed) 296(6614):51–52
Evans RW (1998) Complications of lumbar puncture. Neurol Clin 16(1):83–105
Estcourt LJ, Malouf R, Hopewell S et al (2018) Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia. Cochrane Database Syst Rev 4:CD011980
Kreppel D, Antoniadis G, Seeling W (2003) Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev 26(1):1–49
Moen V, Dahlgren N, Irestedt L (2004) Severe neurological complications after central neuraxial blockades in Sweden 1990-1999. Anesthesiology. 101(4):950–959
Leguit RJ, van den Tweel JG (2010) The pathology of bone marrow failure. Histopathology. 57(5):655–670
Levi M, Toh CH, Thachil J, Watson HG (2009) Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol 145(1):24–33
Neunert CE (2013) Current management of immune thrombocytopenia. Hematology Am Soc Hematol Educ Program 2013:276–282
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. JAMA. 284(17):2222–2224
Foerster MV, Pedrosa Fde P, da Fonseca TC et al (2015) Lumbar punctures in thrombocytopenic children with cancer. Paediatr Anaesth 25(2):206–210
Ning S, Kerbel B, Callum J, Lin Y (2016) Safety of lumbar punctures in patients with thrombocytopenia. Vox Sang 110(4):393–400
Vavricka SR, Walter RB, Irani S, Halter J, Schanz U (2003) Safety of lumbar puncture for adults with acute leukemia and restrictive prophylactic platelet transfusion. Ann Hematol 82(9):570–573
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 leukemia. JAMA. 288(16):2001–2007
Veen JJ, Vora AJ, Welch JC (2004) Lumbar puncture in thrombocytopenic children. Br J Haematol 127(2):233–234 author reply 234-235
Ruff RL, Dougherty JH Jr (1981) Complications of lumbar puncture followed by anticoagulation. Stroke. 12(6):879–881
Edelson RN, Chernik NL, Posner JB (1974) Spinal subdural hematomas complicating lumbar puncture. Arch Neurol 31(2):134–137
Shah KH, Richard KM, Nicholas S et al (2003) Incidence of traumatic lumbar puncture. Acad Emerg Med 10(2):151–154
Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, Cipolle MD, Cohn CS, Fung MK, Grossman BJ, Mintz PD, O'Malley BA, Sesok-Pizzini DA, Shander A, Stack GE, Webert KE, Weinstein R, Welch BG, Whitman GJ, Wong EC, Tobian AAR (2015) Platelet transfusion: a clinical practice guideline from the AABB. Ann Intern Med 162(3):205–213
British Committee for Standards in Haematology BTTF (2003) Guidelines for the use of platelet transfusions. Br J Haematol 122(1):10–23
(2009) 2 Platelet Concentrates. Transfus Med Hemother 36(6):372–382
Gibson BE, Todd A, Roberts I, Pamphilon D, Rodeck C, Bolton-Maggs P, Burbin G, Duguid J, Boulton F, Cohen H, Smith N, McClelland D, Rowley M, Turner G, British Commitee for Standards in Haematology Transfusion Task Force: Writing group (2004) Transfusion guidelines for neonates and older children. Br J Haematol 124(4):433–453
Narayan S (2019) The 2018 Annual SHOT Report. United Kingdom
Gorgone M, McNichols B, Lang VJ, Novak W, O'Connor AB (2018) The procedure coordinator: a resident-driven initiative to increase opportunity for inpatient procedures. J Grad Med Educ 10(5):583–586
Ruell J, Karuvattil R, Wynn R, Will A (2007) Platelet count has no influence on traumatic and bloody lumbar puncture in children undergoing intrathecal chemotherapy. Br J Haematol 136(2):347–348
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Portuguese, A.J., Rothberg, A., Gorgone, M. et al. Safety of bedside lumbar puncture in adult patients with thrombocytopenia. Ann Hematol 99, 1755–1762 (2020). https://doi.org/10.1007/s00277-020-04148-6
- Lumbar puncture
- Traumatic tap
- Platelet transfusion