Lowering Platelet Threshold to 20,000/µL for Fluoroscopy-Guided Lumbar Puncture Does Not Result in Observed Clinical Adverse Outcomes.

ABSTRACT

PURPOSE: Fluoroscopic-guided lumbar puncture (FG-LP) is a common neuroradiologic procedure. Traditionally, a minimum platelet count (MPC) of 50,000/µL for this procedure has been required; however, we recently adopted a lower MPC threshold of 20,000/µL. The purpose of this study was to compare adverse events in patients undergoing FG-LP with MPCs above to those below the conventional 50,000/µL threshold. MATERIALS This was an institutional review board-approved, retrospective study on adult patients with hematologic malignancy undergoing FG-LP in the neuroradiology division between May 2021 and December 2022, after lowering the minimal required MPC to 20,000/µL. Recorded data included indication for FG-LP, preprocedure and postprocedure MPC, need for and number of platelet transfusions within 24 hours of FG-LP, presence of traumatic tap, FG-LP-related complications, and any platelet transfusion-related adverse event. Patients were classified into 2 groups based on MPC (1) those above 50,000/µL and (2) those below 50,000/µL. Descriptive statistics were used comparing these 2 groups. RESULTS: One hundred twenty-eight patients underwent FG-LP, with 46 having an MPC between 20,000 and 50,000/µL and 82 having an MPC above 50,000/µL. No postprocedural complications were encountered in either group. Traumatic taps occurred in 10/46 (22%)​ with MPC below 50,000/µL versus 10/82 (12%)​ in those with MPC above 50,000/µL. Forty of 46 patients (87%) were transfused with platelets within 24 hours prior to FG-LP. One patient developed a transfusion-related reaction. CONCLUSION: Lowering the MPC threshold from 50,000/µL to 20,000/µL for FG-LP did not result in a higher incidence of spinal hematoma.