Can we lower the platelet threshold of ≥ 50 × 109/L for performing a lumbar puncture safely in patients with hematological malignancies?
Lumbar punctures (LP) are routinely used to administer intrathecal chemotherapy for children and adults with hematologic malignancies. The current guidelines suggest a platelet threshold of ≥ 50 × 10 9 /L prior to LP for intrathecal chemotherapy (ITC). This can be challenging in patients with hemato...
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| Veröffentlicht in: | Annals of hematology 2023-03, Vol.102 (3), p.663-668 |
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| creator | Jordan, Aryanna Jain, Akriti G. Koipallil, Gautam Krishna Reddy, Meghana Chakkoli, Sanjay Midha, Shonali Phuoc, Vania Eatrides, Jennifer Erhardt, Crystal Patel, Ankita K. Rico, Juan Visweshar, Nathan Mhaskar, Rahul Parikh, Nainesh Laber, Damian Jaglal, Michael |
| description | Lumbar punctures (LP) are routinely used to administer intrathecal chemotherapy for children and adults with hematologic malignancies. The current guidelines suggest a platelet threshold of ≥ 50 × 10
9
/L prior to LP for intrathecal chemotherapy (ITC). This can be challenging in patients with hematological malignancies who are thrombocytopenic. We conducted a retrospective chart review of 900 LPs for ITC and compared adverse events in patients with a platelet count of ≥ 50 × 10
9
/L and |
| doi_str_mv | 10.1007/s00277-022-05073-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2755801345</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2755801345</sourcerecordid><originalsourceid>FETCH-LOGICAL-c1976-df1a07b3d6b5784145306bb373117c7b4e882d49f76419bd5fec72baeca75ee43</originalsourceid><addsrcrecordid>eNp9kb-qFDEYxYMouK6-gFXAxma8-TuZqUQWrwoLNlqHTOab3VwyyZhkWG5ne2sLn8An8U3uk5h1BcHCFOfjC79zCDkIPafkFSVEXWVCmFINYawhkijetA_Qhgp-XjvxEG1Iz_tG1vMYPcn5hhDKOsE26NvOBHwC7OMJEi5HwIs3BTyUuiTIx-hHHKf7r3f3dz-qSlLl5_cqlPRXezzFhBdIdcwuHLDBfp0HU-_WYMuaAGczgb_FLuDFFAehZHxy5YiPMJsSfTw4azyejXeHYIJ1kF8_RY8m4zM8-zO36PP120-7983-47sPuzf7xtJetc04UUPUwMd2kKoTVEhO2mHgilOqrBoEdB0bRT-pVtB-GOUEVrHBgDVKAgi-RS8vuUuKX1bIRc8uW_DeBIhr1kxJ2RHKa_AWvfgHvYlrCvV1leooYfWrzxS7UDbFnBNMekluNulWU6LPPelLT7r2pH_3pNtq4hdTrnA4QPob_R_XL8HCm7c</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2781024325</pqid></control><display><type>article</type><title>Can we lower the platelet threshold of ≥ 50 × 109/L for performing a lumbar puncture safely in patients with hematological malignancies?</title><source>SpringerLink Journals - AutoHoldings</source><creator>Jordan, Aryanna ; Jain, Akriti G. ; Koipallil, Gautam Krishna ; Reddy, Meghana ; Chakkoli, Sanjay ; Midha, Shonali ; Phuoc, Vania ; Eatrides, Jennifer ; Erhardt, Crystal ; Patel, Ankita K. ; Rico, Juan ; Visweshar, Nathan ; Mhaskar, Rahul ; Parikh, Nainesh ; Laber, Damian ; Jaglal, Michael</creator><creatorcontrib>Jordan, Aryanna ; Jain, Akriti G. ; Koipallil, Gautam Krishna ; Reddy, Meghana ; Chakkoli, Sanjay ; Midha, Shonali ; Phuoc, Vania ; Eatrides, Jennifer ; Erhardt, Crystal ; Patel, Ankita K. ; Rico, Juan ; Visweshar, Nathan ; Mhaskar, Rahul ; Parikh, Nainesh ; Laber, Damian ; Jaglal, Michael</creatorcontrib><description><![CDATA[Lumbar punctures (LP) are routinely used to administer intrathecal chemotherapy for children and adults with hematologic malignancies. The current guidelines suggest a platelet threshold of ≥ 50 × 10
9
/L prior to LP for intrathecal chemotherapy (ITC). This can be challenging in patients with hematological malignancies who are thrombocytopenic. We conducted a retrospective chart review of 900 LPs for ITC and compared adverse events in patients with a platelet count of ≥ 50 × 10
9
/L and < 50 × 10
9
/L. Cohort 1 included 682 LPs (75.8%) with a pre-procedure platelet count ≥ 50 × 10
9
/L, and cohort 2 included 218 LPs (24.2%) with a pre-procedure platelet count < 50 × 10
9
/L. Cohort 2 was further subdivided into pre-procedure platelet counts of 41 × 10
9
/L–49 × 10
9
/L (
n
= 43), 31 × 10
9
/L–40 × 10
9
/L (
n
= 77), 21 × 10
9
/L–30 × 10
9
/L (
n
= 84), and 11 × 10
9
/L–20 × 10
9
/L (
n
= 14). Among 900 LP procedures, a pre-procedure platelet count < 50 × 10
9
/L did not demonstrate a higher rate of post-procedure adverse events (6.5% vs 6.8%,
p
= 0.8237). When cohort 2 was further stratified, the cohort with a pre-procedure platelet count of 21 × 10
9
/L–30 × 10
9
/L had the highest percentage of complications from LP (9.5%) and the highest rates of traumatic taps with observed LP RBC count > 200 (35.7%,
p
= 0.0015). The rate of red blood cells (RBC) in the CSF was significantly higher in the group with platelets < 50 × 10
9
/L with observed LP RBC count ≥ 200 (31.2% vs 20.5%,
p
= 0.0016), ≥ 500 (27.1% vs 14.6%,
p
< 0.0001), and ≥ 1000 (23% vs 11.6%,
p
< 0.0001). No instances of epidural hematomas were seen. We found no significant difference in bleeding complications between patients undergoing LPs for ITC with a platelet count above or below 50 × 10
9
/L.]]></description><identifier>ISSN: 0939-5555</identifier><identifier>EISSN: 1432-0584</identifier><identifier>DOI: 10.1007/s00277-022-05073-6</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Chemotherapy ; Hematology ; Medicine ; Medicine & Public Health ; Oncology ; Original Article</subject><ispartof>Annals of hematology, 2023-03, Vol.102 (3), p.663-668</ispartof><rights>This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2022</rights><rights>This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2022.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c1976-df1a07b3d6b5784145306bb373117c7b4e882d49f76419bd5fec72baeca75ee43</citedby><cites>FETCH-LOGICAL-c1976-df1a07b3d6b5784145306bb373117c7b4e882d49f76419bd5fec72baeca75ee43</cites><orcidid>0000-0002-5546-1213</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00277-022-05073-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00277-022-05073-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids></links><search><creatorcontrib>Jordan, Aryanna</creatorcontrib><creatorcontrib>Jain, Akriti G.</creatorcontrib><creatorcontrib>Koipallil, Gautam Krishna</creatorcontrib><creatorcontrib>Reddy, Meghana</creatorcontrib><creatorcontrib>Chakkoli, Sanjay</creatorcontrib><creatorcontrib>Midha, Shonali</creatorcontrib><creatorcontrib>Phuoc, Vania</creatorcontrib><creatorcontrib>Eatrides, Jennifer</creatorcontrib><creatorcontrib>Erhardt, Crystal</creatorcontrib><creatorcontrib>Patel, Ankita K.</creatorcontrib><creatorcontrib>Rico, Juan</creatorcontrib><creatorcontrib>Visweshar, Nathan</creatorcontrib><creatorcontrib>Mhaskar, Rahul</creatorcontrib><creatorcontrib>Parikh, Nainesh</creatorcontrib><creatorcontrib>Laber, Damian</creatorcontrib><creatorcontrib>Jaglal, Michael</creatorcontrib><title>Can we lower the platelet threshold of ≥ 50 × 109/L for performing a lumbar puncture safely in patients with hematological malignancies?</title><title>Annals of hematology</title><addtitle>Ann Hematol</addtitle><description><![CDATA[Lumbar punctures (LP) are routinely used to administer intrathecal chemotherapy for children and adults with hematologic malignancies. The current guidelines suggest a platelet threshold of ≥ 50 × 10
9
/L prior to LP for intrathecal chemotherapy (ITC). This can be challenging in patients with hematological malignancies who are thrombocytopenic. We conducted a retrospective chart review of 900 LPs for ITC and compared adverse events in patients with a platelet count of ≥ 50 × 10
9
/L and < 50 × 10
9
/L. Cohort 1 included 682 LPs (75.8%) with a pre-procedure platelet count ≥ 50 × 10
9
/L, and cohort 2 included 218 LPs (24.2%) with a pre-procedure platelet count < 50 × 10
9
/L. Cohort 2 was further subdivided into pre-procedure platelet counts of 41 × 10
9
/L–49 × 10
9
/L (
n
= 43), 31 × 10
9
/L–40 × 10
9
/L (
n
= 77), 21 × 10
9
/L–30 × 10
9
/L (
n
= 84), and 11 × 10
9
/L–20 × 10
9
/L (
n
= 14). Among 900 LP procedures, a pre-procedure platelet count < 50 × 10
9
/L did not demonstrate a higher rate of post-procedure adverse events (6.5% vs 6.8%,
p
= 0.8237). When cohort 2 was further stratified, the cohort with a pre-procedure platelet count of 21 × 10
9
/L–30 × 10
9
/L had the highest percentage of complications from LP (9.5%) and the highest rates of traumatic taps with observed LP RBC count > 200 (35.7%,
p
= 0.0015). The rate of red blood cells (RBC) in the CSF was significantly higher in the group with platelets < 50 × 10
9
/L with observed LP RBC count ≥ 200 (31.2% vs 20.5%,
p
= 0.0016), ≥ 500 (27.1% vs 14.6%,
p
< 0.0001), and ≥ 1000 (23% vs 11.6%,
p
< 0.0001). No instances of epidural hematomas were seen. We found no significant difference in bleeding complications between patients undergoing LPs for ITC with a platelet count above or below 50 × 10
9
/L.]]></description><subject>Chemotherapy</subject><subject>Hematology</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Oncology</subject><subject>Original Article</subject><issn>0939-5555</issn><issn>1432-0584</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kb-qFDEYxYMouK6-gFXAxma8-TuZqUQWrwoLNlqHTOab3VwyyZhkWG5ne2sLn8An8U3uk5h1BcHCFOfjC79zCDkIPafkFSVEXWVCmFINYawhkijetA_Qhgp-XjvxEG1Iz_tG1vMYPcn5hhDKOsE26NvOBHwC7OMJEi5HwIs3BTyUuiTIx-hHHKf7r3f3dz-qSlLl5_cqlPRXezzFhBdIdcwuHLDBfp0HU-_WYMuaAGczgb_FLuDFFAehZHxy5YiPMJsSfTw4azyejXeHYIJ1kF8_RY8m4zM8-zO36PP120-7983-47sPuzf7xtJetc04UUPUwMd2kKoTVEhO2mHgilOqrBoEdB0bRT-pVtB-GOUEVrHBgDVKAgi-RS8vuUuKX1bIRc8uW_DeBIhr1kxJ2RHKa_AWvfgHvYlrCvV1leooYfWrzxS7UDbFnBNMekluNulWU6LPPelLT7r2pH_3pNtq4hdTrnA4QPob_R_XL8HCm7c</recordid><startdate>20230301</startdate><enddate>20230301</enddate><creator>Jordan, Aryanna</creator><creator>Jain, Akriti G.</creator><creator>Koipallil, Gautam Krishna</creator><creator>Reddy, Meghana</creator><creator>Chakkoli, Sanjay</creator><creator>Midha, Shonali</creator><creator>Phuoc, Vania</creator><creator>Eatrides, Jennifer</creator><creator>Erhardt, Crystal</creator><creator>Patel, Ankita K.</creator><creator>Rico, Juan</creator><creator>Visweshar, Nathan</creator><creator>Mhaskar, Rahul</creator><creator>Parikh, Nainesh</creator><creator>Laber, Damian</creator><creator>Jaglal, Michael</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5546-1213</orcidid></search><sort><creationdate>20230301</creationdate><title>Can we lower the platelet threshold of ≥ 50 × 109/L for performing a lumbar puncture safely in patients with hematological malignancies?</title><author>Jordan, Aryanna ; Jain, Akriti G. ; Koipallil, Gautam Krishna ; Reddy, Meghana ; Chakkoli, Sanjay ; Midha, Shonali ; Phuoc, Vania ; Eatrides, Jennifer ; Erhardt, Crystal ; Patel, Ankita K. ; Rico, Juan ; Visweshar, Nathan ; Mhaskar, Rahul ; Parikh, Nainesh ; Laber, Damian ; Jaglal, Michael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1976-df1a07b3d6b5784145306bb373117c7b4e882d49f76419bd5fec72baeca75ee43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Chemotherapy</topic><topic>Hematology</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Oncology</topic><topic>Original Article</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jordan, Aryanna</creatorcontrib><creatorcontrib>Jain, Akriti G.</creatorcontrib><creatorcontrib>Koipallil, Gautam Krishna</creatorcontrib><creatorcontrib>Reddy, Meghana</creatorcontrib><creatorcontrib>Chakkoli, Sanjay</creatorcontrib><creatorcontrib>Midha, Shonali</creatorcontrib><creatorcontrib>Phuoc, Vania</creatorcontrib><creatorcontrib>Eatrides, Jennifer</creatorcontrib><creatorcontrib>Erhardt, Crystal</creatorcontrib><creatorcontrib>Patel, Ankita K.</creatorcontrib><creatorcontrib>Rico, Juan</creatorcontrib><creatorcontrib>Visweshar, Nathan</creatorcontrib><creatorcontrib>Mhaskar, Rahul</creatorcontrib><creatorcontrib>Parikh, Nainesh</creatorcontrib><creatorcontrib>Laber, Damian</creatorcontrib><creatorcontrib>Jaglal, Michael</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of hematology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jordan, Aryanna</au><au>Jain, Akriti G.</au><au>Koipallil, Gautam Krishna</au><au>Reddy, Meghana</au><au>Chakkoli, Sanjay</au><au>Midha, Shonali</au><au>Phuoc, Vania</au><au>Eatrides, Jennifer</au><au>Erhardt, Crystal</au><au>Patel, Ankita K.</au><au>Rico, Juan</au><au>Visweshar, Nathan</au><au>Mhaskar, Rahul</au><au>Parikh, Nainesh</au><au>Laber, Damian</au><au>Jaglal, Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Can we lower the platelet threshold of ≥ 50 × 109/L for performing a lumbar puncture safely in patients with hematological malignancies?</atitle><jtitle>Annals of hematology</jtitle><stitle>Ann Hematol</stitle><date>2023-03-01</date><risdate>2023</risdate><volume>102</volume><issue>3</issue><spage>663</spage><epage>668</epage><pages>663-668</pages><issn>0939-5555</issn><eissn>1432-0584</eissn><abstract><![CDATA[Lumbar punctures (LP) are routinely used to administer intrathecal chemotherapy for children and adults with hematologic malignancies. The current guidelines suggest a platelet threshold of ≥ 50 × 10
9
/L prior to LP for intrathecal chemotherapy (ITC). This can be challenging in patients with hematological malignancies who are thrombocytopenic. We conducted a retrospective chart review of 900 LPs for ITC and compared adverse events in patients with a platelet count of ≥ 50 × 10
9
/L and < 50 × 10
9
/L. Cohort 1 included 682 LPs (75.8%) with a pre-procedure platelet count ≥ 50 × 10
9
/L, and cohort 2 included 218 LPs (24.2%) with a pre-procedure platelet count < 50 × 10
9
/L. Cohort 2 was further subdivided into pre-procedure platelet counts of 41 × 10
9
/L–49 × 10
9
/L (
n
= 43), 31 × 10
9
/L–40 × 10
9
/L (
n
= 77), 21 × 10
9
/L–30 × 10
9
/L (
n
= 84), and 11 × 10
9
/L–20 × 10
9
/L (
n
= 14). Among 900 LP procedures, a pre-procedure platelet count < 50 × 10
9
/L did not demonstrate a higher rate of post-procedure adverse events (6.5% vs 6.8%,
p
= 0.8237). When cohort 2 was further stratified, the cohort with a pre-procedure platelet count of 21 × 10
9
/L–30 × 10
9
/L had the highest percentage of complications from LP (9.5%) and the highest rates of traumatic taps with observed LP RBC count > 200 (35.7%,
p
= 0.0015). The rate of red blood cells (RBC) in the CSF was significantly higher in the group with platelets < 50 × 10
9
/L with observed LP RBC count ≥ 200 (31.2% vs 20.5%,
p
= 0.0016), ≥ 500 (27.1% vs 14.6%,
p
< 0.0001), and ≥ 1000 (23% vs 11.6%,
p
< 0.0001). No instances of epidural hematomas were seen. We found no significant difference in bleeding complications between patients undergoing LPs for ITC with a platelet count above or below 50 × 10
9
/L.]]></abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><doi>10.1007/s00277-022-05073-6</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-5546-1213</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0939-5555 |
| ispartof | Annals of hematology, 2023-03, Vol.102 (3), p.663-668 |
| issn | 0939-5555 1432-0584 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2755801345 |
| source | SpringerLink Journals - AutoHoldings |
| subjects | Chemotherapy Hematology Medicine Medicine & Public Health Oncology Original Article |
| title | Can we lower the platelet threshold of ≥ 50 × 109/L for performing a lumbar puncture safely in patients with hematological malignancies? |
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