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Spinal tap for diagnostic purposes and intrathecal administration of chemotherapy in children

General

A spinal tap is performed to examine spinal fluid. The test provides information about intrathecal pressure, cell counts, and cell types. A spinal tap is also used for intrathecal administration of chemotherapy for leukemia and lymphoma. This is done either either prophylactically or for treatment of cancer in the brain membranes (meninges).

Children undergoing this procedure are usually given general anesthesia.

Indications

  • Suspicion of disease in the central nervous system.
  • Intrathecal chemotherapy administration for most leukemias and certain non-Hodgkin lymphomas

Contraindications

  • Thrombocyte values < 20,000 (first give thrombocyte transfusion). For diagnostic spinal tap for leukemia/lymphoma, the number of thrombocytes should be at least > 50,000.
  • INR values > 1.8. If necessary, give fresh frozen plazma or cryoprecipitate first. This should be considered in view of the risk of inadequate anticoagulation.
  • Low molecular weight heparin combined with more than one platelet inhibiting factor.
  • Disseminated intravascular coagulation (DIC).
  • Untreated acute promyelocytic leukemia
  • Fibrinolytic treatment ongoing, or where treatment is finished less than 2 days earlier.

Goal

  • Diagnose disease in the spinal fluid
  • Treat and prevent disease and/or CNS involvement

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