Preoperative predictors of thrombocytopenia in Caesarean delivery: is routine platelet count testing necessary?

  • Robyn Marais Medpharm Publications
  • Lulama Nkomentaba University of KwaZulu-Natal
  • David G Bishop University of KwaZulu-Natal
  • Reitze N Rodseth University of KwaZulu-Natal
Keywords: Caesarean delivery, HIV, obstetrics, pregnancy, thrombocytopaenia

Abstract

Background: Peri-partum thrombocytopenia significantly impacts anaesthetic technique and increases the risk of perioperative bleeding. However, as less than 5% of normal pregnancies have significant thrombocytopenia, routine platelet testing incurs great cost for a relatively low yield. Determining whether clinical predictors, in particular HIV status, are associated with thrombocytopenia may assist clinicians in rationalising preoperative testing. Methods: This was a prospective, observational, single-centre study at a South African regional hospital. We evaluated five variables as candidate predictors for mild preoperative thrombocytopenia (< 150 000/μl) in patients scheduled for both elective and emergency Caesarean delivery: HIV status, pre-eclampsia, urgency of surgery, renal impairment and liver failure. As a subanalysis we compared the incidence of moderate thrombocytopenia (< 100 000/μl) in HIV-positive patients, with HIV-negative patients. Results: We recruited 1 015 patients to this study. The incidence of mild thrombocytopenia was 10.3% (105/1 015). Only preeclampsia was predictive of mild thrombocytopenia (odds ratio 3.51; p < 0.01; 95% confidence interval 2.12–5.82). The incidence of moderate thrombocytopenia was not influenced by HIV status (occurring in 1.5% of HIV-positive patients versus 1.8% in HIV-negative patients; p = 0.716). Conclusions: In this study of predominantly asymptomatic patients scheduled for Caesarean delivery, only pre-eclampsia was predictive of mild thrombocytopenia. In sub-analysis HIV status was not independently associated with moderate thrombocytopenia. All asymptomatic patients, including those who were HIV positive, had platelet counts > 70 000/μl. (Full text available online at www.medpharm.tandfonline.com/ojaa) South Afr J Anaesth Analg 2017; DOI: 10.1080/22201181.2017.1397877

Author Biographies

Lulama Nkomentaba, University of KwaZulu-Natal
Nelson R. Mandela School of Medicine Discipline of Anaesthesia and Critical Care University of KwaZulu-Natal Durban
David G Bishop, University of KwaZulu-Natal
Perioperative Research Group Department of Anaesthetics, Critical Care and Pain Management University of KwaZulu-Natal
Reitze N Rodseth, University of KwaZulu-Natal
Perioperative Research Group Department of Anaesthetics, Critical Care and Pain Management University of KwaZulu-Natal Pietermaritzburg; and Outcomes Research Consortium Cleveland Clinic Cleveland Ohio United States of America
Published
2018-03-19
Section
Research Articles