///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

Using TEG to perform neuraxial anesthesia for cesarean delivery in the setting of pre eclampsia with severe features and thrombocytopenia

Abstract Number: FCD-56
Abstract Type: Case Report Case Series

Leslie Renfro MD1 ; Leslie Renfro MD2; Ryan Childs DO3; Lucas Deschenes MD4

Our patient is a 41 year old Malaysian female who presented to the labor and delivery suite at 39 weeks gestation with premature rupture of membranes and on admission was diagnosed with preeclampsia with severe features. She has a medical history of refractory aplastic anemia with resultant severe thrombocytopenia. Her complete blood count on admission was significant for pancytopenia with a white blood cell count of 2.2 x10^9/L, hemoglobin of 9.7 g/dL, and platelets of 16 x10^9/L. Her admission chemistry profile was grossly within normal limits and her liver function tests were normal (ALT 10 U/L, AST 30 U/L). She was started on a magnesium infusion and labor was induced with oxytocin and misoprostol. She was given two units of platelets with goal of >20 x10^9/L for vaginal delivery, however due to failed induction of labor and uptrending liver function tests (ALT 16 U/L, AST 81 U/L) concerning for HELLP syndrome, the decision was made to proceed with a cesarean delivery. Her platelet count two hours prior to this decision was 18 and we utilized thromboelastography (TEG) to get a more complete picture of her coagulation profile. Her TEG result was completely within normal limits (figure 1) suggesting preserved hemostatic function despite her severe thrombocytopenia and preeclampsia with severe features. At this time, the patient was grossly edemetous with a MPIII airway. After discussion with the obstetric team and informed consent from the patient, we proceeded with spinal anesthesia. In the operating room, routine noninvasive monitoring was established. Her baseline blood pressure was 145/92 mmHg, heart rate was 92 beats per minute, and SpO2 was 99% on room air. EKG showed normal sinus rhythm. The patient was placed in a sitting position and 2mL lidocaine was used for local anesthesia at the L3-4 interspace. A 24-gauge pencan needle was inserted through the introducer. After clear cerebrospinal fluid was detected, and after aspiration was negative for heme, 1.6 mL 0.75% hyperbaric bupivacaine, 15 micrograms of fentanyl and 150 micrograms of morphine was injected into the intrathecal space with a bilateral T4 level. Her cesarean section was uneventful. Postoperatively she was given a transversus abdominal plane block. Over the following days, her magnesium infusion was titrated down and by postoperative day one her aplastic anemia began to improve. She was discharged to home with close follow up on postoperative day five.

SOAP 2019