A new case report and literature review assesses the use of electroconvulsive therapy (ECT) in patients with paroxysmal nocturnal hemoglobinuria (PNH) and thrombocytopenia. The case report, published in CNS Spectrums, was that of a woman with PNH and significant thrombocytopenia, and only 2 published cases were found describing ECT in patients with thrombocytopenia.

“Although there are no absolute contraindications to performing ECT, the risks and benefits need to be assessed in all patients,” the authors wrote. “We present a patient with a history of [PNH] with significant thrombocytopenia, who completed an index course of six ECT sessions without complication.”

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The 37-year-old woman had various additional conditions including pancytopenia, major depressive disorder, panic disorder, and suicidal ideation. Selective serotonin reuptake inhibitors (SSRIs) had failed to resolve her depression, so ECT was proposed following a platelet transfusion if her platelet count was less than 20×103/mL.

Given that her platelet count ranged from 24 to 40×103/mL, the patient was not given a preprocedural transfusion and underwent 6 sessions of ECT without complications.

The 2 previous cases included a woman with a platelet count ranging from 7 to 38×103/mL who underwent 12 sessions of ECT without complications and a man with a platelet count of less than 20×103/mL who underwent 9 sessions of ECT and 8 transfusions. His head computed tomography scan showed no structural alterations or hemorrhage, and the authors were not certain that the transfusions were necessary.

The authors note that ECT has been shown to be one of the most effective therapies for treatment-resistant depression. However, the risks and benefits must be assessed, and there is a notable lack of studies and literature on platelet goals in patients with thrombocytopenia prior to the use of ECT.

The authors recommend further research to identify cut-off points and risk factors for platelet transfusion prior to conducting ECT in this patient group.


Nearine J, Ongchuan S. Electroconvulsive therapy in thrombocytopenic patients: a case report and literature review. CNS Spectrums. 2023;28(2):234. doi:10.1017/S109285292300161X