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 accessOne-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 AnesthesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Severe neurological complications after central neuraxial blockades in Sweden 1990–1999.Anesthesiology. 2004; 101: 950-959https://doi.org/10.1097/00000542-200410000-00021
- 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
- Platelet counts during pregnancy.N Engl J Med. 2018; 379: 32-43https://doi.org/10.1056/NEJMoa1802897
- Managing ITP and thrombocytopenia in pregnancy.Platelets. 2020; 31: 300-306https://doi.org/10.1080/09537104.2019.1640870
- Bisoprolol-induced thrombocytopenia: a case report.J Clin Pharm Ther. 2018; 43: 280-283https://doi.org/10.1111/jcpt.12614
- Drug-induced thrombocytopenia: mechanisms and laboratory diagnostics.Semin Thromb Hemost. 2020; 46: 264-274https://doi.org/10.1055/s-0039-1697930
- Cefepime: a novel cause of thrombocytopaenia.BMJ Case Rep. 2022; : 15https://doi.org/10.1136/bcr-2021-243749
- 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
- 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
- Cefazolin-induced neutropenia and thrombocytopenia following trauma: a case report.Mil Med. 2012; 177: 352-354https://doi.org/10.7205/milmed-d-11-00319
- Hemolytic anemia and pancytopenia induced by cefoxitin.Drug Intell Clin Pharm. 1983; 17: 816-818https://doi.org/10.1177/106002808301701106
- 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
- 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
- Thrombocytopenia possibly caused by structurally related third-generation cephalosporins.Dicp. 1991; 25: 135-136https://doi.org/10.1177/106002809102500206
- Cefepime-associated thrombocytopenia in a critically ill patient.Int J Clin Pharm. 2011; 33: 902-904https://doi.org/10.1007/s11096-011-9571-5
- 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
- In vivo glucocorticoid modulation of guinea pig splenic macrophage Fc gamma receptors.J Clin Invest. 1991; 88: 149-157https://doi.org/10.1172/jci115271
- Plasma therapies in thrombotic syndromes.Int J Artif Organs. 2005; 28: 459-465https://doi.org/10.1177/039139880502800506
- 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
Article info
Publication history
Published online: October 28, 2022
Accepted:
October 21,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.