Lumbar puncture in thrombocytopenic adults with leukemia and lymphoma revisited: A scoping review.

Abstract

e18612 Background: Patients with hematological malignancies may require a lumbar puncture (LP) for evaluation of central nervous system involvement as well as for intrathecal injection of chemotherapy. Severe thrombocytopenia in these patients can increase the risk of bleeding complications, and current guidelines recommend avoidance of LP in patients with thrombocytopenia below 50 ×10⁹/L. This review aims to re-evaluate the safety of LP in adults with hematologic malignancies in the setting of thrombocytopenia. Methods: Literature was reviewed in PubMed, Scopus, and Google Scholar for eligible articles. Inclusion criteria were adults above 18 with leukemia or lymphoma who required LP or intrathecal injection of chemotherapy with thrombocytopenia. Exclusion criteria were pediatric population, bone marrow transplant patients, and non-English articles. Two reviewers independently screened studies for eligibility and extracted data. Results: Eight observational studies met the inclusion criteria. The studies included >66,000 patients with LP with >4,700 LP performed at platelet counts <50 ×10⁹/L without a significant increase in bleeding. Conclusions: The studies of lumbar puncture and thrombocytopenia were heterogeneous; they included both adult and pediatric populations, as well as studies combining hematologic and solid malignancies. Despite these limitations, retrospective data suggest that LP performed at platelet counts below 50 ×10⁹/L is associated with a higher rate of traumatic taps, without a corresponding increase in clinically significant hemorrhagic complications. Importantly, LP was reported to be safe below platelet counts of 40×10⁹/L, supporting consideration of a lower platelet threshold at 40 ×10⁹/L. Studies evaluating lumbar puncture safety in thrombocytopenic adults with hematologic malignancies. Article Number of Patients / LPs Platelet Count at LP Outcome Vavricka et al., 2003 66 20–30 (35 LPs), 31–50 (40), 51–100 (43), >100 (77) no hemorrhagic complications; more traumatic LPs at lower platelet counts Öztürk et al., 2021 42 <100k in 41%; <50k in 18%; untransfused LPs <30k (7 ) No hematoma after LP Chung et al., 2020 Adults 871; Peds 266 <50 ×10⁹/L: 110 LPs; ≥50 ×10⁹/L: 2,149 LPs Platelets <50 ×10⁹/qaL did not increase complications Jordan et al., 2023 900 LPs ≥50 ×10⁹/L: 682 LPs; <50 ×10⁹/L: 218 LPs Lowering threshold <50 ×10⁹/L did not increase bleeding; higher traumatic taps at lower counts Corrao et al., 2025 345 <40k: 39 LPs; 40–49k: 120; ≥50k: 1,073 4 hematomas total; lowering the threshold to 40k did not increase bleeding risk Ning et al., 2016 135 patients; 369 LPs ≤50 ×10⁹/L: 28 LPs No hemorrhagic complications; traumatic taps similar across groups Portuguese et al., 2020 262 ≤50 ×10⁹/L: 19 LPs Severe thrombocytopenia increased traumatic taps; no significant bleeding Bodilsen et al., 2020 64,730 <50 ×10⁹/L: 4,236 LPs Traumatic taps are common; major bleeding not reported