Iron and an Epidural

JilllyBean

So, I was talking to one of my friends who had a baby in July and she said they wouldn't give her an epidural because her iron was too low. I have never heard this in my life! Have you guys? Is this common practice? How low are we talking? Anyone know anything about this? I know I am not pregnant yet, but that freaks me out!

jschwind22

When I saw this title my first thought was of an iron used on clothes lol.  My eyes got all big and I couldn't imagine the crazy that was inside.

Peanutz21

Maybe they meant platelets instead of iron?

swirl25

They probably meant platelets. They can't administer the epidural if you have a low platelet count. I had a low platelet count in 3rd tri w/ DD and they kept checking the levels every appt. It eventually went back up so I was fine to get one if I wanted. But they ended up not being able to find a good spot to put in the needle so I couldn't get an epi anyway...but that's another story!

Bakes4u

I've had two kids two epidurals and not once was iron mentioned.

WashingtonQueen

My iron was low through my whole pregnancy and I ended up having to get an epidural. Your friend does not make sense.

caramia582

swirl25:

They probably meant platelets. They can't administer the epidural if you have a low platelet count. I had a low platelet count in 3rd tri w/ DD and they kept checking the levels every appt. It eventually went back up so I was fine to get one if I wanted. But they ended up not being able to find a good spot to put in the needle so I couldn't get an epi anyway...but that's another story!

This is what I was going to say.  I am pretty sure she is getting it confused with platelets.  I remember needing to wait for them to test my platelets before I could get an epi... cue moment of panic, since they had never mentioned that to me beforehand! 

pantherRN

JilllyBean:

So, I was talking to one of my friends who had a baby in July and she said they wouldn't give her an epidural because her iron was too low. I have never heard this in my life! Have you guys? Is this common practice? How low are we talking? Anyone know anything about this? I know I am not pregnant yet, but that freaks me out!

Not an L&D nurse (ICU nurse), but if your platelet count or your blood pressure are too low you cannot get an epi.

With low platelets, the concern is that you could bleed into your epidural space and not clot, which would be bad. The epi can drop your pressure, which is why BP is a concern too. 

ETA: Sometimes medical professionals will sort of use different terms than we normally would so that non-medical professionals can understand us. Whoever explained the reasoning to your friend may have used a generic term, such as iron, to help your friend understand. Someone who is not versed in medical terms may not understand hemoglobin, hematocrit, and platelet count. 

JilllyBean

Good to know! I wasn't sure if it was true. I tried to google, but didn't come up with much. I obviously don't need to worry about it yet, but thought I would see if any of the TTGP ladies knew anything about it!

pantherRN

redaero:

pantherRN got it with her ninja-ICU nurse skillz, it's the bleed into the epidural space you'd be worried about. Hematomas associated with epidurals can have some very serious consequences, if I remember right.

 

This is true. The clot will put pressure on the tissues around it. Depending where the clot is, depends on the severity and symptoms. It's like a stroke. 

redaero:

I'm just trying to decide whether there's some instance where you wouldn't want to give an anemic mom an epidural. Like pantherRN said, if her pressure was already too low, you wouldn't do it... but maybe if she's anemic they just don't want to mess about with low BP and fluid resuscitation? 

 

Again, not an L&D nurse, but I would imagine it depends on the person's trend and the facility's policy. I would think that placing an epidural in someone who has chronically low platelets would be different than placing an epidural in someone who has an acute drop in their platelet count. 

I know we have some OB nurses, I'm sure they are much, much more familiar with this than me. 

redaero:

Hey pantherRN! Do you mess up somebody's clotting factors with too much IV fluid? 

You can, but it takes a good amount of fluid. I'm talking multiple liters, not the liter or two you may get during labor. It also depends on the quality of the blood draw.

rissa06

gonzol:

I find this to be bullsht. I have/had low Iron w/ DS. I had an epi no problem. They didn't even question.

this! 

ourwedding111111

comeongetdown:

wow, I have researched epidurals (I have had a spinal fusion, wanted to make sure I was still in the running) and I have not come across anything like this.

If you're legitimately concerned, I would ask your anesthesiologist if it's indeed an issue.

 

I have an artificial disc and a fusion as well, I've had epidurals in the past and I'm with comeongetdown, I've *never* heard that.   

curlylocks3

Peanutz21:

Maybe they meant platelets instead of iron?

Ding ding ding!

Stffhappns

LD RN here, and they meant platelets, although I hve no idea why someone would have said iron to try to explain it in nonmedical terms. We routinely draw CBCs on patients to check hemoglobin and hematocrit ad a baseline and to compare with postdelivery hgb/hct. A CBC also includes platelets, and if they are too low, you are at risk of developing epidural or spinal hematoma. Hope this helps.

JilllyBean

Stffhappns:

LD RN here, and they meant platelets, although I hve no idea why someone would have said iron to try to explain it in nonmedical terms. We routinely draw CBCs on patients to check hemoglobin and hematocrit ad a baseline and to compare with postdelivery hgb/hct. A CBC also includes platelets, and if they are too low, you are at risk of developing epidural or spinal hematoma. Hope this helps.

Thanks it does! Is it common? I hadn't ever heard of it happening

kerriw147

jschwind22:

When I saw this title my first thought was of an iron used on clothes lol.  My eyes got all big and I couldn't imagine the crazy that was inside.

LOL!

Stffhappns

JilllyBean:

ps.

Thanks it does! Is it common? I hadn't ever heard of it happening

No it's not common at all, but the risks associated with these two complications are so high that anesthesiologists just won't take the chance. Most women with platelets low enough to cause problems usually have known platelet problems or are very sick Preeclampsia or HELLP syndrome though.