372 posters, 1 audios, 13 topics, 29 sessions, 1,035 authors, 449 institutions

51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting

April 16 - 18, 2026 | Phoenix, Arizona

2313933

Clinical Decision Making for Neuraxial versus General Anesthesia in Thrombocytopenic Patients

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Poster Presenter

Cassandra Alexis Cu

Authors

Cassandra W. Cu, Uchenna O. Umeh

Affiliations

Tufts University School of Medicine, Hospital for Special Surgery, Weill Cornell Medicine

Part of Topic

Medically Challenging Cases

Clinical Decision Making for Neuraxial versus General Anesthesia in Thrombocytopenic Patients

Cassandra W. Cu MSc,1 Uchenna O. Umeh MD, FASA, FASRA2,3

1 School of Medicine, Tufts University School of Medicine, Boston, MA, USA; 2 Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY, USA, 3Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA

Introduction:

•Spinal and epidural hematomas are rare but potentially devastating complications of neuraxial anesthesia in thrombocytopenic patients (rates range from 1:10,000 to 1:200,000 procedures).1

•Most expert consensus and meta-analyses recommend a platelet (PLT) count of at least 70,000-80,000/μL for safe neuraxial anesthesia, although it can be lower for obstetric patients.1,2

•A comprehensive risk-benefit assessment is essential, with consideration of alternative anesthesia techniques, when platelet counts are below recommended thresholds or when additional risk factors, like platelet dysfunction or anticoagulation, are present.1,3

Methods:

•No patient identifiable information is reported therefore per HSS IRB guidelines, it is IRB exempt. Patient informed consent was obtained for submission.

•We describe three cases of patients with history of moderate (50,000K -100,000K) thrombocytopenia presenting for joint arthroplasty surgery.

•Decision making for anesthesia type – neuraxial versus general – was determined by the anesthesiologist and/or patient preference.

Case 1:

55-year-old female with a history of liver cirrhosis secondary to alcohol abuse, hemochromatosis, osteoarthritis, cholelithiasis, and thrombocytopenia presenting for left hip replacement. Previous surgery, right hip replacement on 22July2025 done under GA for PLT count of 91K. Spinal anesthesia placed without any complications.

Case 2:

Case 3:

60-year-old female with a history of diabetes, and idiopathic thrombocytopenia and monocytosis, presenting for left knee replacement. 12Sept2025 (45K), which led to a postponed knee replacement procedure. Hematologist recommended dexamethasone 40mg x 4 days completed on 19Sept2025 and platelet count increased temporarily. On day of surgery (DOS), platelet count was 71K. General anesthesia was selected after discussion with surgeon and hematologist. Decadron was given preoperatively and 1 unit platelet was transfused prior to surgical incision per hematologist recommendation.

Discussion:

•Anesthesiologists undertake clinical decision making for neuraxial versus general when presented with patients with moderate thrombocytopenia. Despite the risks of potential epidural hematoma following neuraxial anesthesia, patients with chronic thrombocytopenia undergo neuraxial anesthesia without major complications.

•Neuraxial techniques may be carefully considered in patients with stable platelet counts below traditional thresholds. Until more comprehensive data is available, clinical decisions should be individualized, led by consensus recommendations, patient-specific factors, and multidisciplinary guidance.

References:

1. Bauer ME, Arendt K, Beilin Y, et al. The Society for Obstetric Anesthesia and PerinatologyInterdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients WithThrombocytopenia. Anesth Analg. Jun 1 2021;132(6):1531–1544. doi:10.1213/ane.0000000000005355

2. Peterson W, Martin R, Arnold D, et al. Delphi consensus recommendations for neuraxial anesthesia inadults with platelet disorders and coagulation defects: communication from the ISTH SSC Subcommittee onvon Willebrand Factor. Journal of Thrombosis and Haemostasis. 2025;23(6):2039–2049.doi:10.1016/j.jtha.2025.01.019

3. Estcourt LJ, Malouf R, Hopewell S, Doree C, Van Veen J. Use of platelet transfusions prior to lumbarpunctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia.Cochrane Database Syst Rev. 2018 Apr 30;4(4):CD011980. doi: 10.1002/14651858.CD011980.pub3. PMID:29709077; PMCID: PMC5957267