ESSENTIAL THROMBOCYTHEMIA AND EPIDURAL ANALGESIA IN THE PARTURIENT - DOES THROMBOELASTOGRAPHY HELP

Background and Objectives. It is often considered that essential throm bocythemia contraindicates placement of an epidural catheter because o f the danger of epidural hematoma. Thromboelastography offers a possib le means of determining the appropriateness of epidural analgesia in a patient with this disorder. Methods. A pregnant woman with essential thrombocythemia and a history of spontaneous abortions was evaluated b y thromboelastography at 38 weeks of gestation to determine the safety of using epidural analgesia for labor pain management. On the basis o f the thermoelastography findings, the patient was given epidural anal gesia with bupivacaine and fentanyl during her labor. Results. The pat ient experienced good pain relief, delivered a healthy infant vaginall y, and suffered no complications. Conclusions. Thromboelastography may be a useful diagnostic test in determining the suitability of regiona l techniques for labor analgesia in parturients with essential thrombo cythemia. However, success in one patient does not prove the general s afety of this approach.