Safe use of low-molecular-weight heparin in pediatric acute lymphoblastic leukemia and lymphoma around lumbar punctures

Jeremie H. Estepp, Matthew P. Smeltzer, Guolian Kang, Scott Howard, Ulrike M. Reiss

Research output: Contribution to journalArticle

Abstract

Children with acute lymphoblastic leukemia or lymphoma (ALL) undergo multiple lumbar punctures (LPs) and frequently require low-molecular-weight heparin (LMWH) for thromboembolic complications. We evaluated if withholding LMWH 24 hours before and after LPs prevented bleeding complications. Children (n=133) with ALL from who were: (1) treated at St. Jude Children's Research Hospital, (2) received LMWH (2×/day of 1 mg/kg) between January 2004 until December 2012, and (3) underwent a LP were analyzed. Spinal hematoma was defined as a clinical suspicion leading to diagnostic imaging. Traumatic LP was defined as ≥10 red blood cells per microliter of cerebrospinal fluid. In 1708 LPs, no hematomas occurred. For each child treated with LMWH, the probability of experiencing a spinal hematoma during the entire ALL treatment course was 0% (95% confidence interval [CI], 0.0%-2.7%), and in each LP, assuming no intrapatient correlation, the probability of spinal hematoma was 0% (95% CI, 0.0%-0.2%). Traumatic LPs were more common when performed when children were not receiving LMWH therapy (odds ratio [OR], 1.5; 95% CI, 1.1-2.2) which may be explained by clinician optimization of known risk factors for traumatic cerebrospinal fluid before the procedures. Withholding LMWH for 24 hours before and after LPs in children being treated for ALL is safe.

Original languageEnglish (US)
Pages (from-to)596-601
Number of pages6
JournalJournal of pediatric hematology/oncology
Volume39
Issue number8
DOIs
StatePublished - Jan 1 2017

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Spinal Puncture
Low Molecular Weight Heparin
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Pediatrics
Hematoma
Confidence Intervals
Cerebrospinal Fluid
Diagnostic Imaging
Erythrocytes
Odds Ratio
Hemorrhage
Therapeutics
Research

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Safe use of low-molecular-weight heparin in pediatric acute lymphoblastic leukemia and lymphoma around lumbar punctures. / Estepp, Jeremie H.; Smeltzer, Matthew P.; Kang, Guolian; Howard, Scott; Reiss, Ulrike M.

In: Journal of pediatric hematology/oncology, Vol. 39, No. 8, 01.01.2017, p. 596-601.

Research output: Contribution to journalArticle

Estepp, Jeremie H. ; Smeltzer, Matthew P. ; Kang, Guolian ; Howard, Scott ; Reiss, Ulrike M. / Safe use of low-molecular-weight heparin in pediatric acute lymphoblastic leukemia and lymphoma around lumbar punctures. In: Journal of pediatric hematology/oncology. 2017 ; Vol. 39, No. 8. pp. 596-601.
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