[Epidural hematoma following epidural catheter anesthesia in thrombocytopenia]

We report a 21-year-old male patient suffering from acute myeloid leukemia and concomitant thrombocytopenia. Following a diagnostic thoracotomy-which revealed Aspergillus pneumonia-he developed respiratory insufficiency and dyspnea. A thoracic epidural catheter was inserted and epidural morphine treatment led to improved ventilation. No clinical signs of pathological epidural processes were noticed during the treatment. The patient died of Aspergillus sepsis 26 days after catheter insertion. Autopsy revealed bacterial growth in the epidural space with slight infectious tissue reactions as well as an epidural hematoma. No evidence of spinal cord compression was found at autopsy. The development of epidural infection or hematoma seems to be a possible complication of epidural analgesia in patients suffering from impaired defense mechanisms or thrombocytopenia. These risk factors should be taken into account when epidural analgesia is considered. We suggest that the platelet count should be determined beforehand in patients suspected of having thrombocytopenia (e.g. cancer, pre-eclampsia).