IV gammaglobulin for ITP before epidural anesthesisa.

The Cut-off platelet cound is not known. Older literature says: one hundred thousand.

While IVIG has some role in presurgical situations, plt. ct of sixty eight is probably not sufficient for the proposed surgery and would be justified. A recent review says:  "Normally, spinal or epidural anesthesia is considered safe if the platelet count is over 80,000/µl. However, the consistently low platelet counts in ITP seem to be less problematic than rapidly falling values due to other diseases, because this is often accompanied by platelet dysfunction or coagulopathy. In several studies neuraxial anesthesia was successfully performed with platelet counts between 50,000 and 80,000/µl. Nevertheless, the minimum safe platelet count for neuraxial blockade remains undefined in these patients."

 

Englbrecht JS, Pogatzki-Zahn EM, Zahn P.Spinal and epidural anesthesia in patients with hemorrhagic diathesis : Decisions on the brink of minimum evidenceAnaesthesist. 2011 Jul 31