INTRODUCTION/AIMS: Needle electromyography (EMG) is understood to be a relatively safe procedure based on clinical experience. There are no evidence-based guidelines for EMG procedures in thrombocytopenic patients. The purpose of this study was to determine whether there is an increased risk of bleeding complications associated with needle EMG in patients with thrombocytopenia. METHODS: This retrospective study included patients with a primary cancer and thrombocytopenia who underwent needle EMG between January 1, 2016 and October 30, 2020. Patient medical records were reviewed for demographics, diagnoses, platelet counts within a 7-day period of EMG examination, concurrent use of anti-coagulants or anti-platelet medications, number of sites sampled by needle EMG including anatomical differentiation of paraspinal, deep and superficial limb muscles, and associated complications not limited to bleeding within 30 days of EMG examination. RESULTS: The initial data search identified 198 patients with a documented diagnosis of thrombocytopenia; 124 met criteria and were included in the study. 1001 total muscle sample sites were documented with 111 sites in paraspinal muscles, 876 sites in superficial limb muscles and 14 sites within deep limb muscles. Five patients were concurrently using therapeutic anti-coagulation and three patients were using anti-platelet medications. There were no clinically significant complications, but 5 minor incidents were documented in the medical records within 30 days post-EMG examination. DISCUSSION: Our findings suggest that bleeding complications from standard needle EMG in oncology patients with documented thrombocytopenia are rare. Testing of high risk-muscles in this patient population appears to be safe.