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Essential Thrombocytosis and Labor Epidural Placement While on Aspirin: Assessing Hemorrhagic Risks: A Case Report
1From the Department of Anesthesiology, Weirton Medical Center, Weirton, West Virginia.
A & a Case Reports
|May 19, 2017
Summary
Essential thrombocytosis (ET) patients on aspirin therapy can safely receive labor epidurals. Point-of-care platelet function testing confirmed adequate platelet function for safe epidural placement in a JAK2-negative ET case.
Area of Science:
- Hematology
- Anesthesiology
- Obstetrics
Background:
- Essential thrombocytosis (ET) is a rare myeloproliferative neoplasm.
- ET patients face risks of thrombotic and bleeding complications.
- Management of ET requires careful consideration, especially during procedures like labor epidurals.
Observation:
- A patient with longstanding Janus kinase-2 (JAK2) gene-negative ET, on aspirin therapy, presented for labor epidural anesthesia.
- Point-of-care platelet function testing using Plateletworks was performed in a community hospital setting.
- The testing aimed to assess platelet function for safe epidural placement.
Findings:
- Platelet function testing confirmed adequate numbers of functional platelets.
- This confirmation supported the safe placement of a labor epidural.
- Unique and unexpected findings from the platelet function testing were observed and are discussed.
Implications:
- This case highlights the importance of assessing platelet function in ET patients undergoing procedures.
- Point-of-care testing can provide rapid, actionable data for anesthesia management.
- Safe management strategies for ET patients requiring neuraxial anesthesia can be developed based on such evaluations.
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