Case Report: Urgent ultrasound-guided dual-lumen PICC placement after platelet transfusion in severe aplastic anemia with extreme thrombocytopenia.

Background: Patients with severe aplastic anemia (SAA) proceeding to allogeneic hematopoietic cell transplantation (HCT) require reliable central venous access, yet the procedural evidence base was generated at platelet counts of roughly 10-50 × 10 Case description: A 56-year-old woman with SAA, neutropenia, fungal maxillary sinusitis, scattered ecchymoses, and no active spontaneous bleeding required urgent multi-lumen access before conditioning. Her admission platelet count was 1 × 10 Intervention and outcomes: After multidisciplinary review, a second 200-mL apheresis platelet transfusion was given and a 5-Fr dual-lumen power-injectable PICC was inserted immediately afterward through the right basilic vein under ultrasound guidance. Insertion followed the transfusion without an interval, so the last recorded count of 2 × 10 Conclusion: This report documents how a coordinated risk-control pathway combining necessity assessment, platelet support, a compressible access site, first-pass ultrasound-guided insertion, and interval-specific surveillance was applied when transplantation could not be deferred, and it specifies the measurements that future prospective series should capture. A single case cannot establish the safety of PICC placement at extremely low platelet counts or define a platelet threshold, particularly because the count at the time of insertion was not remeasured.