• Jacob Weinstein, Daniel Shatalin, Sorina Grisaru-Granovsky, Yaacov Gozal, and Alexander Ioscovich.
• Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Jerusalem, Israel, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
• Isr Med Assoc J. 2024 Aug 1; 26 (7): 410414410-414.

BackgroundCesarean delivery (CD) is one of the most common surgeries performed worldwide, with increasing yearly rates. Although neuraxial techniques remain the preferred anesthesia method for CD, maternal thrombocytopenia remains a prominent contraindication. Formation of spinal\epidural hematomas are extremely rare, however the minimal thrombocyte count required for safe neuraxial anesthesia is still under debate. Although transfusion of thrombocytes for the purpose of neuraxial anesthesia is still not recommended, patients with severe thrombocytopenia (less than 50 × 103/uL) are given thrombocyte transfusion for surgical hemostasis.ObjectivesTo evaluate the anesthetic approach to caesarean deliveries in parturients with severe thrombocytopenia who received thrombocyte transfusion aimed for improved surgical hemostasis.MethodsWe conducted a single center, retrospective cohort study. Results: A total of five cases were found, four of which were given spinal anesthesia immediately following thrombocyte transfusion. One patient was denied spinal anesthesia because her thrombocyte count following transfusion failed to reach safe levels. None of our cases had anesthesia-related complications recorded.ConclusionsWe examined the anesthetic management parturients with severe thrombocytopenia who needed cesarean delivery and were transfused with thrombocytes for surgical hemostasis. In such cases, spinal anesthesia may be considered due to the serious risks associated with general anesthesia.

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