Low Risk of Hemorrhagic Complications Following Diagnostic Skin Biopsies Performed in a Cohort of Thrombocytopenic Inpatients

Abstract

Background: Guidelines for performing skin biopsies in patients with thrombocytopenia are highly varied. No data exists regarding bleeding risk after diagnostic skin biopsies in thrombocytopenic patients. Objective: In this study, we evaluate the risk of bleeding after skin biopsies in hospitalized patients with thrombocytopenia and other bleeding risk factors. Methods: We reviewed the medical records of 205 thrombocytopenic (platelets <150,000/µL) patients who underwent diagnostic skin biopsies as an inpatient at the Brigham and Women’s Hospital and Massachusetts General Hospital from 2000-2015. Results: We identified one case of bleeding, which consisted of oozing from a punch biopsy site that was left to heal by secondary intent. The bleeding risk of 1 out of 205 (0.49%) was equivalent to the literature data on bleeding risk after inpatient skin biopsy for non-thrombocytopenic patients. None of the 75 patients with platelets ≤ 20,000/µL in our study had bleeding complications. 44 (21.5%) patients were on anticoagulation or antiplatelet agents at the time of biopsy, and 6 (2.9%) patients had recent active bleeding. Conclusions: These results suggest that bleeding risk is low even in high-risk thrombocytopenic patients. This finding should reduce physician discomfort regarding performing skin biopsies in thrombocytopenic patients, reduce variability regarding platelet threshold above which to perform skin biopsies, and eliminate unnecessary platelet transfusions for thrombocytopenic patients prior to biopsy.