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

Scott Howard, Amar Gajjar, Raul C. Ribeiro, Gaston K. Rivera, Jeffrey E. Rubnitz, John T. Sandlund, Patricia L. Harrison, Alberto De Armendi, Gary V. Dahl, Ching Hon Pui

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Abstract

Context: 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. Design, Setting, and Patients: 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. Interventions: All patients underwent a diagnostic LP followed by a median of 4 LPs to instill intrathecal chemotherapy. Main Outcome Measure: 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 109/L or less, 170 at platelet counts of 11 to 20 x 109/L, and 742 at platelet counts of 21 to 50 x 109/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 109/L or less was 0% to 1.75% and that for the 941 patients with platelet counts of 50 x 109/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 109/L. Due to the small number of patients in our study with platelet counts of 10 x 109/L or less, conclusions cannot yet be drawn for such patients.

Original languageEnglish (US)
Pages (from-to)2222-2224
Number of pages3
JournalJournal of the American Medical Association
Volume284
Issue number17
DOIs
StatePublished - Nov 1 2000

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Spinal Puncture
Platelet Count
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Thrombocytopenia
Safety
Remission Induction
Platelet Transfusion
Nervous System
Outcome Assessment (Health Care)
Confidence Intervals
Pediatrics
Hemorrhage
Drug Therapy

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Howard, S., Gajjar, A., Ribeiro, R. C., Rivera, G. K., Rubnitz, J. E., Sandlund, J. T., ... Pui, C. H. (2000). Safety of lumbar puncture for children with acute lymphoblastic leukemia and thrombocytopenia. Journal of the American Medical Association, 284(17), 2222-2224. https://doi.org/10.1001/jama.284.17.2222

Safety of lumbar puncture for children with acute lymphoblastic leukemia and thrombocytopenia. / Howard, Scott; Gajjar, Amar; Ribeiro, Raul C.; Rivera, Gaston K.; Rubnitz, Jeffrey E.; Sandlund, John T.; Harrison, Patricia L.; De Armendi, Alberto; Dahl, Gary V.; Pui, Ching Hon.

In: Journal of the American Medical Association, Vol. 284, No. 17, 01.11.2000, p. 2222-2224.

Research output: Contribution to journalArticle

Howard, S, Gajjar, A, Ribeiro, RC, Rivera, GK, Rubnitz, JE, Sandlund, JT, Harrison, PL, De Armendi, A, Dahl, GV & Pui, CH 2000, 'Safety of lumbar puncture for children with acute lymphoblastic leukemia and thrombocytopenia', Journal of the American Medical Association, vol. 284, no. 17, pp. 2222-2224. https://doi.org/10.1001/jama.284.17.2222
Howard, Scott ; Gajjar, Amar ; Ribeiro, Raul C. ; Rivera, Gaston K. ; Rubnitz, Jeffrey E. ; Sandlund, John T. ; Harrison, Patricia L. ; De Armendi, Alberto ; Dahl, Gary V. ; Pui, Ching Hon. / Safety of lumbar puncture for children with acute lymphoblastic leukemia and thrombocytopenia. In: Journal of the American Medical Association. 2000 ; Vol. 284, No. 17. pp. 2222-2224.
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abstract = "Context: 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. Design, Setting, and Patients: 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. Interventions: All patients underwent a diagnostic LP followed by a median of 4 LPs to instill intrathecal chemotherapy. Main Outcome Measure: 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 109/L or less, 170 at platelet counts of 11 to 20 x 109/L, and 742 at platelet counts of 21 to 50 x 109/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 109/L or less was 0{\%} to 1.75{\%} and that for the 941 patients with platelet counts of 50 x 109/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 109/L. Due to the small number of patients in our study with platelet counts of 10 x 109/L or less, conclusions cannot yet be drawn for such patients.",
author = "Scott Howard and Amar Gajjar and Ribeiro, {Raul C.} and Rivera, {Gaston K.} and Rubnitz, {Jeffrey E.} and Sandlund, {John T.} and Harrison, {Patricia L.} and {De Armendi}, Alberto and Dahl, {Gary V.} and Pui, {Ching Hon}",
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AU - Howard, Scott

AU - Gajjar, Amar

AU - Ribeiro, Raul C.

AU - Rivera, Gaston K.

AU - Rubnitz, Jeffrey E.

AU - Sandlund, John T.

AU - Harrison, Patricia L.

AU - De Armendi, Alberto

AU - Dahl, Gary V.

AU - Pui, Ching Hon

PY - 2000/11/1

Y1 - 2000/11/1

N2 - Context: 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. Design, Setting, and Patients: 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. Interventions: All patients underwent a diagnostic LP followed by a median of 4 LPs to instill intrathecal chemotherapy. Main Outcome Measure: 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 109/L or less, 170 at platelet counts of 11 to 20 x 109/L, and 742 at platelet counts of 21 to 50 x 109/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 109/L or less was 0% to 1.75% and that for the 941 patients with platelet counts of 50 x 109/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 109/L. Due to the small number of patients in our study with platelet counts of 10 x 109/L or less, conclusions cannot yet be drawn for such patients.

AB - Context: 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. Design, Setting, and Patients: 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. Interventions: All patients underwent a diagnostic LP followed by a median of 4 LPs to instill intrathecal chemotherapy. Main Outcome Measure: 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 109/L or less, 170 at platelet counts of 11 to 20 x 109/L, and 742 at platelet counts of 21 to 50 x 109/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 109/L or less was 0% to 1.75% and that for the 941 patients with platelet counts of 50 x 109/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 109/L. Due to the small number of patients in our study with platelet counts of 10 x 109/L or less, conclusions cannot yet be drawn for such patients.

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