Advertisement

Acute thrombocytopenia during cesarean section

  • X. Yang
    Affiliations
    Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, Xinshi District, Xinjiang Province, China
    Search for articles by this author
  • Q. Xia
    Affiliations
    Department of Hematology, The First Affiliated Hospital of Xinjiang Medical University, Xinshi District, Xinjiang Province, China
    Search for articles by this author
  • J. Wang
    Correspondence
    Correspondence to: J. Wang, Department of Anesthesiology, The First Affiliated Hospital of Xingjiang Medical University, Xinshi District, 830000 Xinjiang province, China.
    Affiliations
    Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, Xinshi District, Xinjiang Province, China
    Search for articles by this author
Published:October 28, 2022DOI:https://doi.org/10.1016/j.ijoa.2022.103612

      Highlights

      • Combined spinal-epidural anesthesia for elective cesarean section.
      • Heathy parturient with a normal pre-operative platelet count.
      • Acute intra-operative development of severe thrombocytopenia (3 × 109/L)
      • Likely an adverse reaction to cefoxitin given for surgical infection prophylaxis.
      • No spinal-epidural hematoma despite severe thrombocytopenia.

      Abstract

      We report a case of a healthy 29-year-old parturient with a normal pre-operative platelet count who received combined spinal-epidural anesthesia for cesarean section, and who suffered the sudden intra-operative onset of severe thrombocytopenia (platelet count 3 × 109/L). This event was likely due to cefoxitin administered for the prophylaxis of surgical infection.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Obstetric Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Moen V.
        • Dahlgren N.
        • Irestedt L.
        Severe neurological complications after central neuraxial blockades in Sweden 1990–1999.
        Anesthesiology. 2004; 101: 950-959https://doi.org/10.1097/00000542-200410000-00021
        • Bauer M.E.
        • Arendt K.
        • Beilin Y.
        • et al.
        The Society for Obstetric Anesthesia and Perinatology interdisciplinary consensus statement on neuraxial procedures in obstetric patients with thrombocytopenia.
        Anesth Analg. 2021; 132: 1531-1544https://doi.org/10.1213/ane.0000000000005355
        • Reese J.A.
        • Peck J.D.
        • Deschamps D.R.
        • et al.
        Platelet counts during pregnancy.
        N Engl J Med. 2018; 379: 32-43https://doi.org/10.1056/NEJMoa1802897
        • Eslick R.
        • McLintock C.
        Managing ITP and thrombocytopenia in pregnancy.
        Platelets. 2020; 31: 300-306https://doi.org/10.1080/09537104.2019.1640870
        • Mousinho F.
        • Mendes T.
        • Sousa E.S.P.
        • et al.
        Bisoprolol-induced thrombocytopenia: a case report.
        J Clin Pharm Ther. 2018; 43: 280-283https://doi.org/10.1111/jcpt.12614
        • Danese E.
        • Montagnana M.
        • Favaloro E.J.
        • Lippi G.
        Drug-induced thrombocytopenia: mechanisms and laboratory diagnostics.
        Semin Thromb Hemost. 2020; 46: 264-274https://doi.org/10.1055/s-0039-1697930
        • Muhammad S.
        • Ahmad S.
        • Khan B.A.
        • Yousaf A.
        Cefepime: a novel cause of thrombocytopaenia.
        BMJ Case Rep. 2022; : 15https://doi.org/10.1136/bcr-2021-243749
        • Salamon D.J.
        • Nusbacher J.
        • Stroupe T.
        • Wilson J.H.
        • Hanrahan J.B.
        Red cell and platelet-bound IgG penicillin antibodies in a patient with thrombocytopenia.
        Transfusion. 1984; 24: 395-398https://doi.org/10.1046/j.1537-2995.1984.24585017827.x
        • Grossjohann B.
        • Eichler P.
        • Greinacher A.
        • Santoso S.
        • Kroll H.
        Ceftriaxone causes drug-induced immune thrombocytopenia and hemolytic anemia: characterization of targets on platelets and red blood cells.
        Transfusion. 2004; 44: 1033-1040https://doi.org/10.1111/j.1537-2995.2004.03378.x
        • Walker A.S.
        • Causey M.W.
        • Sebesta J.A.
        Cefazolin-induced neutropenia and thrombocytopenia following trauma: a case report.
        Mil Med. 2012; 177: 352-354https://doi.org/10.7205/milmed-d-11-00319
        • DeTorres O.H.
        Hemolytic anemia and pancytopenia induced by cefoxitin.
        Drug Intell Clin Pharm. 1983; 17: 816-818https://doi.org/10.1177/106002808301701106
        • Eskazan A.E.
        • Salihoglu A.
        • Gulturk E.
        • Ongoren S.
        • Soysal T.
        Thrombotic thrombocytopenic purpura after prophylactic cefuroxime axetil administered in relation to a liposuction procedure.
        Aesthetic Plast Surg. 2012; 36: 464-467https://doi.org/10.1007/s00266-011-9794-9
        • Onodera M.
        • Fujino Y.
        • Inoue Y.
        • Kikuchi S.
        • Endo S.
        Hematoma of the iliopsoas muscle due to thrombocytopenia resulting from the administration of a third-generation cephalosporin.
        Ann Hematol. 2010; 89: 825-826https://doi.org/10.1007/s00277-009-0872-x
        • Hull R.L.
        • Brandon D.
        Thrombocytopenia possibly caused by structurally related third-generation cephalosporins.
        Dicp. 1991; 25: 135-136https://doi.org/10.1177/106002809102500206
        • Lim P.P.
        • Chong C.P.
        • Aziz N.A.
        Cefepime-associated thrombocytopenia in a critically ill patient.
        Int J Clin Pharm. 2011; 33: 902-904https://doi.org/10.1007/s11096-011-9571-5
        • Crow A.R.
        • Song S.
        • Semple J.W.
        • Freedman J.
        • Lazarus A.H.
        IVIg inhibits reticuloendothelial system function and ameliorates murine passive-immune thrombocytopenia independent of anti-idiotype reactivity.
        Br J Haematol. 2001; 115: 679-686https://doi.org/10.1046/j.1365-2141.2001.03136.x
        • Ruiz P.
        • Gomez F.
        • King M.
        • Lopez R.
        • Darby C.
        • Schreiber A.D.
        In vivo glucocorticoid modulation of guinea pig splenic macrophage Fc gamma receptors.
        J Clin Invest. 1991; 88: 149-157https://doi.org/10.1172/jci115271
        • Nguyen T.C.
        • Stegmayr B.
        • Busund R.
        • Bunchman T.E.
        • Carcillo J.A.
        Plasma therapies in thrombotic syndromes.
        Int J Artif Organs. 2005; 28: 459-465https://doi.org/10.1177/039139880502800506
        • Breivik H.
        • Norum H.
        • Fenger-Eriksen C.
        • et al.
        Reducing risk of spinal haematoma from spinal and epidural pain procedures.
        Scand J Pain. 2018; 18: 129-150https://doi.org/10.1515/sjpain-2018-0041