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Safety of Lumbar Puncture for Children With Acute Lymphoblastic Leukemia and Thrombocytopenia
Scott C. Howard, MD;
Amar Gajjar, MD;
Raul C. Ribeiro, MD;
Gaston K. Rivera, MD;
Jeffrey E. Rubnitz, MD, PhD;
John T. Sandlund, MD;
Patricia L. Harrison, MPH;
Alberto de Armendi, MD;
Gary V. Dahl, MD;
Ching-Hon Pui, MD
JAMA. 2000;284:2222-2224.
Context Patients with thrombocytopenia are at risk for spontaneous or procedure-related hemorrhage. Whether such patients can safely undergo lumbar puncture (LP) without prophylactic platelet transfusion is unknown.
Objective To determine whether an association exists between thrombocytopenia and LP complications among children with acute lymphoblastic leukemia.
Design, Setting, and Patients Retrospective review of the records of 958 consecutive children (median age, 5.5 years) with newly diagnosed acute lymphoblastic leukemia who were treated at a pediatric cancer center between February 1984 and July 1998.
Interventions All patients underwent a diagnostic LP followed by a median of 4 LPs to instill intrathecal chemotherapy.
Main Outcome Measure Serious complications of LP occurring during the remission induction and consolidation treatment periods (when thrombocytopenia is likely to occur), defined as any neurologic, infectious, or hemorrhagic problems related to the procedure, reported by platelet count at the time of the procedure.
Results Of the 5223 LPs evaluated, 29 were performed at platelet counts of 10 x 109/L or less, 170 at platelet counts of 11 to 20 x 109/L, and 742 at platelet counts of 21 to 50 x 109/L. No serious complications were encountered, regardless of the platelet count. The 95% confidence interval for the proportion of serious complications in the 199 patients with platelet counts of 20 x 109/L or less was 0% to 1.75% and that for the 941 patients with platelet counts of 50 x 109/L or less was 0% to 0.37%.
Conclusions In our study of children undergoing remission induction or consolidation therapy for acute lymphoblastic leukemia, serious complications of LP were not observed, regardless of platelet count. Prophylactic platelet transfusion is not necessary in children with platelet counts higher than 10 x 109/L. Due to the small number of patients in our study with platelet counts of 10 x 109/L or less, conclusions cannot yet be drawn for such patients.
Author Affiliations: Departments of Hematology-Oncology (Drs Howard, Gajjar, Ribeiro, Rivera, Rubnitz, Sandlund, and Pui), Biostatistics and Epidemiology (Ms Harrison), Pathology (Dr Pui), and Anesthesiology (Dr de Armendi), St Jude Children's Research Hospital, and Department of Pediatrics, University of Tennessee College of Medicine (Drs Gajjar, Ribeiro, Rivera, Rubnitz, Sandlund, and Pui), Memphis, Tenn; and Department of Pediatrics (Dr Dahl), Stanford University School of Medicine, Stanford, Calif.
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