Howard S C, Gajjar A, Ribeiro R C, Rivera G K, Rubnitz J E, Sandlund J T, Harrison P L, de Armendi A, Dahl G V, Pui C H
Department of Hematology-Oncology, ALSAC Bldg, Room C6005, St Jude Children's Research Hospital, 332 N Lauderdale St, Memphis, TN 38105-2794, USA.
JAMA. 2000 Nov 1;284(17):2222-4. doi: 10.1001/jama.284.17.2222.
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.
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.
All patients underwent a diagnostic LP followed by a median of 4 LPs to instill intrathecal chemotherapy.
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.
Of the 5223 LPs evaluated, 29 were performed at platelet counts of 10 x 10(9)/L or less, 170 at platelet counts of 11 to 20 x 10(9)/L, and 742 at platelet counts of 21 to 50 x 10(9)/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 10(9)/L or less was 0% to 1.75% and that for the 941 patients with platelet counts of 50 x 10(9)/L or less was 0% to 0.37%.
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 10(9)/L. Due to the small number of patients in our study with platelet counts of 10 x 10(9)/L or less, conclusions cannot yet be drawn for such patients. JAMA. 2000;284:2222-2224.
血小板减少症患者有发生自发性出血或与操作相关出血的风险。此类患者在不进行预防性血小板输注的情况下能否安全地接受腰椎穿刺（LP）尚不清楚。
确定急性淋巴细胞白血病患儿血小板减少与腰椎穿刺并发症之间是否存在关联。
设计、地点和患者：对1984年2月至1998年7月在一家儿科癌症中心接受治疗的958例新诊断的急性淋巴细胞白血病患儿（中位年龄5.5岁）的记录进行回顾性研究。
所有患者均接受了诊断性腰椎穿刺，随后平均进行4次腰椎穿刺以注入鞘内化疗药物。
缓解诱导期和巩固治疗期（此时可能出现血小板减少）发生的腰椎穿刺严重并发症，定义为与该操作相关的任何神经、感染或出血问题，按操作时的血小板计数报告。
在评估的5223次腰椎穿刺中，29次是在血小板计数为10×10⁹/L或更低时进行的，170次是在血小板计数为11至20×10⁹/L时进行的，742次是在血小板计数为21至50×10⁹/L时进行的。无论血小板计数如何，均未遇到严重并发症。血小板计数为20×10⁹/L或更低的199例患者中严重并发症比例的95%置信区间为0%至1.75%，血小板计数为50×10⁹/L或更低的941例患者中该比例的95%置信区间为0%至0.37%。
在我们对接受急性淋巴细胞白血病缓解诱导或巩固治疗的患儿的研究中，无论血小板计数如何，均未观察到腰椎穿刺严重并发症。血小板计数高于10×10⁹/L的患儿无需进行预防性血小板输注。由于我们研究中血小板计数为10×10⁹/L或更低的患者数量较少，目前尚不能就此类患者得出结论。《美国医学会杂志》。2000年；284:2222 - 2224。
