Hemostatic profile in patients with and without postpartum hemorrhage / Perfil hemostático en pacientes con y sin hemorragia obstétrica posparto

Background: The association between coagulation profile and postpartum hemorrhage (PH) is still debated. Objective: To determine the association between hemostatic profile and PH in women with cesarean operation (CO). Methods: We included 92 patients with PH (cases) and 184 without (controls), patients were attended during 2014, at one hospital of the Instituto Mexicano del Seguro Social in Mérida, Yucatán. Demographic, clinical and laboratory data including prothrombin time (PT), activated partial thromboplastin time (aPTT), platelet count (PLC), and fibrinogen concentration were compared among cases and controls using a binary logistic regression model (LRM), from which odd ratios (OR), and 95% confidence intervals (95% CI), were obtained. Results: According to the bivariate comparison, in the LRM categorical data such as parity, any type of hypertensive comorbidity, type of anesthesia, and categorized aPTT (< 38 vs. ≥ 38 seconds), and one continuous variable (gestational age) were included. Having some hypertensive comorbidity (OR 3.55, 95% CI: 1.95-6.47), type of anesthesia (regional anesthesia, OR 0.27, 95% CI: 0.13-0.55) and aPTT (< 38 seconds, OR 0.26, 95% CI: 0.10-0.66) were all statistically significant. Categorized PT, platelet count and fibrinogen concentration, were not statistically significant. Conclusions: In this sample, having some hypertensive comorbidity increased risk of PH more than three times, while regional anesthesia and aPTT < 38 seconds reduced risk in 73% and 74%, respectively. Neither platelet count, nor fibrinogen concentration, or the PT categories modified risk of PH.

Introducción: la asociación entre el perfil hemostático y la hemorragia obstétrica posparto (HO) es controversial. Objetivo: determinar la asociación entre el perfil hemostático y la HO en pacientes con operación cesárea (OC). Métodos: se incluyeron 92 pacientes con HO (casos) y 184 sin HO (controles), atendidas durante 2014 en un hospital del Instituto Mexicano del Seguro Social de Mérida, Yucatán. Diversas variables, incluyendo la cuenta plaquetaria, el tiempo de protrombina (TP), el tiempo de tromboplastina parcial activado (TTPa) y el fibrinógeno plasmático, fueron comparadas entre casos y controles, mediante un modelo de regresión logística del que se obtuvieron razones de momios (RM) e intervalos de confianza de 95% (IC 95%). Resultados: con base en el análisis univariado se incluyeron en el modelo la paridad, comorbilidad hipertensiva (hipertensión crónica, preeclampsia, eclampsia), tipo de anestesia y el TTPa categorizado (< 38 frente a ≥ 38 segundos) y la edad gestacional (como dato continuo), resultando significativamente diferentes la presencia de comorbilidad hipertensiva (RM 3.55, IC 95%: 1.95-6.47), el tipo de anestesia (regional, RM 0.27, IC 95%: 0.13-0.55) y el TTPa (< 38 segundos, RM 0.26, IC 95%: 0.10-0.66). Conclusiones: en esta muestra, tener comorbilidad hipertensiva incrementó más de tres veces el riesgo de HO, la anestesia regional lo redujo en 73% y el TTPa < 38 segundos lo redujo en 74%. Ni el TP, ni la cuenta plaquetaria modificaron el riesgo.

Lumbar punctures in thrombocytopenic children with cancer.

INTRODUCTION: Lumbar punctures (LP) in patients presenting thrombocytopenia are linked to the possibility of bleeding and spinal hematomas. The minimum platelet count required for the safe performance of spinal procedures is still under discussion. Children with some oncology diseases require routinely lumbar punctures; such patients often present thrombocytopenia, making this group an ideal population to study the association between lumbar puncture in thrombocytopenic patients and complications. OBJECTIVES: To determine the platelet count of oncology children undergone lumbar punctures and the occurrence of spinal hematomas. METHOD: Observational longitudinal study. It included a retrospective analysis of electronic medical records of oncology patients submitted to LP for intrathecal chemotherapy between January 2004 and October 2011, carried out at the 'Instituto de Medicina Integral Prof. Fernando Figueira (IMIP)', Recife, Brazil. RESULTS: We evaluated 9088 lumbar punctures performed in 440 patients. The platelet count distribution before lumbar punctures was as follows: 25 punctures had zero to 10,000 platelets per mm(3), 67 punctures had between 10,000 and 20,000 platelets per mm(3), 88 had between 20,000 and 30,000 platelets per mm(3), 92 punctures had between 30,000 and 40,000 platelets per mm(3), 107 punctures had between 40,000 and 50,000 platelets per mm(3), and 729 punctures had between 50,000 and 100,000 platelets per mm(3). In this series, the incidence of bloody tap was 16.9% (1112 lumbar punctures of 6552 had more than ten erythrocytes). No complications were observed. CONCLUSIONS: Even in thrombocytopenic patient, an epidural hematoma would be a relatively rare complication following lumbar puncture. Despite the large number of punctures performed on patients with platelet counts below 100,000 mm(-3) (n = 1108), further studies are necessary in order to determine a lower safe platelet count threshold for the performance of lumbar punctures in healthy patients undergoing neuraxial anesthesia.