Port-A-Cath insertions in acute leukemia: does thrombocytopenia affect morbidity?
BACKGROUND
Unnecessary delay of insertion of Port-A-Cath indwelling venous catheters in thrombocytopenic patients may result from fear of potential morbidity. This study sought to compare the morbidity of Port-A-Cath insertions in acute leukemic patients with platelet counts below and above 50 x 10(9)/L.


METHODS
Incidence and profile of catheter-related bloodstream infections (CRBSIs) and other complications were determined in 80 consecutive Port-A-Cath insertions in pediatric patients with acute leukemia from January 2002 to December 2004. Subgroup analysis was performed for patients with platelet levels below and above the recommended safe level of 50 x 10(9)/L.


RESULTS
Twenty-two (27.5%) patients had insertions performed at platelet levels below the recommended level (median, 35.3; range, 10-49 x 10(9)/L); postoperative counts were correspondingly higher (median, 66.0; range, 20-207 x 10(9)/L) with perioperative platelet transfusion. Catheter-related bloodstream infection incidence was similar in patients with platelets less than and greater than the recommended threshold (18.2% vs 17.2%, respectively), and likewise for CRBSIs encountered in the immediate 30 postoperative days (4.6% and 5.2%, respectively). Only 2 episodes of postoperative bleeding occurred, both in the group with platelet counts greater than 50 x 10(9)/L, with an equally low incidence of other local and mechanical complications in both subgroups. Patient demographics and other preoperative blood parameters did not differ significantly.


CONCLUSIONS
Preoperative thrombocytopenia was not associated with increased incidence of postoperative complications for Port-A-Cath insertions in acute leukemic children.
Loh
Amos Hong Pheng
AH
Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore 229899, Singapore. aloh@alumni.nus.edu.sg
Chui
Chan Hon
CH
D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000188:drug therapy*; D008297:Male; D010976:Platelet Count; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology; D012846:Singapore / Q000453:epidemiology; D013921:Thrombocytopenia / Q000150:complications*
D000970:Antineoplastic Agents