Transjugular liver biopsy in patients with hematologic malignancy and severe thrombocytopenia

PURPOSE: The purposes of this study are to report experience with transjugular liver biopsy (TJLB) in patients with hematologic malignancy and severe thrombocytopenia and to determine the incidence of hemorrhage-related complications in patients with prebiopsy and pretransfusion platelet counts of 30 × 10⁹ /L or lower to propose a threshold platelet count above which TJLB can be safely performed without transfusion. MATERIALS AND METHODS: Medical records and laboratory reports of 50 patients with severe thrombocytopenia who had undergone 51 TJLB procedures and prebiopsy platelet transfusions between August 1999 and September 2001 were retrospectively reviewed. Biopsy success and procedural complications were recorded. RESULTS: TJLB was technically successful in 49 of 51 procedures (96%). The mean prebiopsy, pretransfusion platelet count was 17 × 10⁹/L (range, 3-30 × 10⁹/L) and a mean of 11 U (range, 6-32 U) of platelets per patient were transfused. The overall mean postbiopsy platelet count was 38 × 10⁹/L (range, 5-105 × 10⁹/L), but it remained 30 × 10⁹/L or lower in 24 TJLB procedures. No hemorrhage-related complications were encountered, but ventricular fibrillation occurred in one patient during the procedure. CONCLUSION: A threshold platelet count for safe TJLB resides below 30 × 10⁹/L. A prospective study is necessary to better define a lower threshold above which TJLB can be performed without platelet transfusion.