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Epidural blood patch in leukemia patient: a case report
Zara Y Mergan1, Nicole Khetani, Dajie Wang
1Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Pain Medicine (Malden, Mass.)
|July 22, 2014
Summary
This case study shows that an epidural blood patch (EBP) can safely treat post-dural puncture headaches in acute lymphoblastic leukemia (ALL) patients. Careful screening for cancer cells is crucial to minimize risks.
Area of Science:
- Oncology
- Anesthesiology
- Neurology
Background:
- Post-dural puncture headache (PDPH) is a recognized complication of intrathecal chemotherapy.
- Epidural blood patch (EBP) is an effective treatment for PDPH.
- Patients with hematological malignancies pose unique risks for EBP due to potential neuroaxial seeding of cancer cells.
Observation:
- A 46-year-old male with adult T-cell acute lymphoblastic leukemia (ALL) developed PDPH after intrathecal methotrexate.
- The patient received an EBP for symptom relief.
- Pre-procedural screening using flow cytometry identified no circulating blast cells.
Findings:
- The patient experienced complete resolution of his headache post-EBP.
- No evidence of ALL central nervous system involvement was noted 3 months after the procedure.
- This case demonstrates the feasibility of EBP in ALL patients with appropriate safety measures.
Implications:
- EBP can be a safe and effective treatment option for PDPH in ALL patients.
- Screening for circulating malignancy cells is essential before performing EBP in this population.
- Further research is needed to establish definitive guidelines for EBP in patients with hematological malignancies.
