Do you maintain a strict platelet threshold of > 50k when performing a lumbar puncture, or are there situations in which you feel comfortable with a lower threshold?  

While many US guidelines have supported a threshold of > 50k, there does not appear to be robust data to support it. Notably, 2025 AABB and ICTMG International Clinical Practice Guidelines recommend a lower cutoff of < 20k for pre-procedural platelet transfusion.