Safety of lumbar puncture for children with acute lymphoblastic leukemia and thrombocytopenia.
BACKGROUND
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.


OBJECTIVE
To determine whether an association exists between thrombocytopenia and LP complications among children with acute lymphoblastic leukemia.


METHODS
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.


METHODS
All patients underwent a diagnostic LP followed by a median of 4 LPs to instill intrathecal chemotherapy.


METHODS
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.


RESULTS
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%.


CONCLUSIONS
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.
Howard
S C
SC
Department of Hematology-Oncology, ALSAC Bldg, Room C6005, St Jude Children's Research Hospital, 332 N Lauderdale St, Memphis, TN 38105-2794, USA. scott.howard@stjude.org
Gajjar
A
A
Ribeiro
R C
RC
Rivera
G K
GK
Rubnitz
J E
JE
Sandlund
J T
JT
Harrison
P L
PL
de Armendi
A
A
Dahl
G V
GV
Pui
C H
CH
D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007223:Infant; D007278:Injections, Spinal; D008297:Male; D010976:Platelet Count; D017713:Platelet Transfusion; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D012074:Remission Induction; D012189:Retrospective Studies; D013129:Spinal Puncture / Q000009:adverse effects; D013921:Thrombocytopenia / Q000150:complications*
D000970:Antineoplastic Agents