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Re: As if I didnt have enough problems?From: Gary Kleinman (fuf@gulf.net)Sat Dec 9 20:06:32 1995
2 days ago our anesthesiology group (exclusive contract with hospital) informed us that they would not provide epidural anesthesia for patients with platelet counts below the norm for our lab (130,000 - 400,000). They said that their malpractice carrier sent them articles stating that it was too risky medicolegaly to provide this service for parturients with platelet counts < 130,000. Today, the anesthesiologist on call declined to place an epidural for induction of labor in an eclamptic 34 week patient becuase the platelet count was 140,000.(This patient was also a sickle-beta thal compound heterozygote with a painful crisis. She was about to receive a partial exchange transfusio prior to induction. Her BP's are 150/90 average with 2+ urinary protein. She is on magnesium sulfate) The anesthesiologist said that for preeclamptics, platelet counts should be >150,000 for epidural anesthesia. We were advised that since alternative anesthesia exists, such medicolegal risks will not be tolerated. I quoted written opinions that epidural and subarachnoid hematomas are very rarely associated with thrombocytopenia unless platelet counts are well below 100K. I also believe that the actions of the anesthesia group may place themselves as well as the hospital and medical staff at even greater risk of a lawsuit. Could the anesthesia group have a valid point?
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