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Retrospective Analysis of Thrombocytopenia in Pre-eclampsia with and without Severe Features
Abstract Number: T-49
Abstract Type: Original Research
Introduction: Currently, there is no evidence based method to define the timing of platelet assessment prior to neuraxial anesthesia in preeclamptic patients. Of concern to anesthesiologists is the potential for spinal hematoma formation in preeclamptic patients with thrombocytopenia. This retrospective study examines platelet assessments in preeclamptic patients to determine the potential time progression to clinically significant thrombocytopenia (<100K or <75K).
Methods: We performed a search of billing records at the University of Illinois Hospital (11-1-2011 to 12-9-2015) for patients with Delivery CPT codes and ICD-9 or 10 codes for the diagnosis of preeclampsia, HELLP, gestational hypertension, or cHTN . Charts were hand searched to verify inclusion criteria of age (13-49), a dx of preeclampsia at time of delivery, and viable pregnancy. Platelet values at admission , 6-12hrs, 12-18hrs, 18-24hrs, and 24 hours, clinical symptoms and vitals were recorded from charts if available.
Results: Of 598 patients, 266 patients met inclusion criteria. 62 were without severe features, 156 had severe features , 37 had superimposed preeclampsia, and 11 had HELLP.
The mean admission platelet counts were: 217K in preeclampsia without severe features, 224K with severe features, 241K in superimposed preeclampsia, and 174K in patients with HELLP.
Thirteen patients had platelets <100K, 6 had a value <75K, during their hospital course. Of the 62 without severe features, 0% became thrombocytopenic. In patients with severe feature preeclampsia 2% developed thrombocytopenia : 1.2% at admission, 0% at < 12 hours and 0.6% at >24h. Of the patients who had superimposed preeclampsia, 2.7% had platelets <100K at admission. Of those with HELLP 72% were thrombocytopenic at admission and 9% converted after 12 hrs. (Figure 1).
Discussion: Presently, there is no standard among anesthesiologists for the time frame of platelet assessment prior to neuraxial in preeclamptic patients. The limitations of our study include the small number of identified patients and retrospective data. Performing this study prospectively would be challenging given the rarity of clinically relevant thrombocytopenia in preeclamptic patients. Our study demonstrates it is unlikely for patients without severe features of preeclampsia to develop clinically significant thrombocytopenia within 12h of admission; those who present with thrombocytopenia or have severe features warrant more frequent lab evaluation.