Can spinal anaesthesia be performed now for a caesarean section in a day‑1 dengue patient who is afebrile with a platelet count of 159 ×10⁹/L and no evidence of coagulopathy?

Spinal Anaesthesia for Caesarean Section in Day-1 Dengue Patient

Yes, spinal anaesthesia can be safely performed now for this caesarean section in a day-1 dengue patient who is afebrile with a platelet count of 159 ×10⁹/L, as this platelet level is well above the minimum threshold of 75,000 ×10⁹/L recommended for neuraxial procedures in obstetric patients with normal platelet function. 1

Key Decision Points

Platelet Count Assessment

• The patient's platelet count of 159 ×10⁹/L exceeds all safety thresholds for neuraxial anaesthesia in obstetric patients 1
• Guidelines recommend a minimum platelet count of 75,000 ×10⁹/L for neuraxial procedures in obstetric populations, provided platelet function is expected to be normal 1
• The most recent 2025 ISTH consensus recommends platelet counts ≥75 ×10⁹/L for neuraxial anaesthesia in patients with platelet disorders and mild bleeding history 1

Dengue-Specific Considerations

• Dengue infection itself is NOT a contraindication to neuraxial anaesthesia 1
• The patient being afebrile on day 1 and having a platelet count of 159 ×10⁹/L indicates early, non-severe disease 2
• Routine indications and contraindications for neuraxial anaesthesia apply when managing dengue patients 1

Additional Safety Checks Required Before Proceeding

• Verify absence of coagulopathy by checking PT/INR and aPTT, as dengue can cause coagulation abnormalities independent of platelet count 2
• Confirm no clinical bleeding manifestations (petechiae, mucosal bleeding, hematuria) 3, 4
• Ensure no signs of severe dengue (plasma leakage, severe bleeding, organ impairment) 3

Why Neuraxial Anaesthesia is Preferred

Advantages Over General Anaesthesia

• Neuraxial anaesthesia should be the preferred technique for caesarean section to avoid risks of difficult intubation, pulmonary aspiration, and inferior postoperative analgesia associated with general anaesthesia in pregnant women 1
• General anaesthesia carries higher maternal risks in obstetric patients and should be reserved for situations with contraindications to neuraxial techniques 1

Evidence from Viral Infections

• Studies of obstetric patients with COVID-19 infection demonstrated safe neuraxial anaesthesia use with no contraindications, haemodynamic instability, or neurological complications in patients without thrombocytopenia or sepsis 1
• This experience with viral infections supports the safety of neuraxial techniques in dengue patients meeting platelet thresholds 1

Critical Monitoring Points

Intraoperative Management

• Be prepared to manage hypotension with vasopressors, as neuraxial anaesthesia can cause hypotension regardless of dengue status 1
• Use standard aseptic techniques as for non-dengue patients 1
• Avoid reducing spinal anaesthetic doses, as conversion to general anaesthesia is the least desirable outcome 1

Laboratory Surveillance

• Although conventional coagulation tests (PT, aPTT) are typically normal in dengue patients with thrombocytopenia, thromboelastometry studies show hypocoagulability in 71.7% of dengue patients despite normal standard tests 2
• This discrepancy suggests checking coagulation parameters before proceeding, even with adequate platelet counts 2

Common Pitfalls to Avoid

• Do not delay necessary caesarean section waiting for higher platelet counts when the current level (159 ×10⁹/L) is already safe 1
• Do not assume bleeding risk correlates directly with platelet count in dengue, as platelet counts do not correlate well with clinical bleeding 3
• Do not overlook coagulation abnormalities that may exist despite normal platelet counts in dengue patients 2
• Bleeding complications in dengue can occur at platelet counts up to 70,000/mm³, but this patient's count of 159,000/mm³ provides substantial safety margin 4

Contraindications That Would Change This Decision

Neuraxial anaesthesia should be deferred or avoided if:

• Platelet count drops below 75,000 ×10⁹/L 1
• Evidence of coagulopathy (INR >2.0, aPTT >60 seconds) develops 4
• Clinical bleeding manifestations appear 3, 4
• Signs of severe dengue with plasma leakage or organ dysfunction emerge 3
• Sepsis or haemodynamic instability develops 1