A Case of Symptomatic Haemolytic Anaemia in Pregnancy

Craig, G. A.; Turner, Robert L.

doi:10.1136/bmj.1.4920.1003

Cited by 18 publications

(9 citation statements)

References 5 publications

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“…Treatment was required in 3 infants and complete recovery occurred in all cases. There were 7 subsequent pregnancies and live deliveries [5,[7][8][9]12]; 2 of the children were affected with haemolytic disease which required treatment [8,9], 2 of the 3 cases of infant loss in these patients occurred where the AIH had been severe in pregnancy and it is felt that the mortality was a reflection of the anaemia, rather than of haemolytic dis ease in the child [5,10]. The third fetal death was thought to have been due to obstetric complications [12].…”

Section: Discussionmentioning

confidence: 99%

Erythrocyte Autoantibodies, Autoimmune Haemolysis and Pregnancy

Sokol¹,

Hewitt²,

Stamps³

1982

Vox Sanguinis

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The clinical and serological records of 20 pregnant patients with erythrocyte autoantibodies were critically reviewed and analysed. This series, the largest reported, confirmed an association between erythrocyte autosensitization and pregnancy, and suggested that this occurred on an average of 1 in 50,000 pregnancies. The clinical presentation varied from severe haemolytic anaemia to serological abnormalities discovered during the routine testing of well patients; overt haemolysis was present in 7 cases. Treatment was only necessary in 3 patients where the haemolysis was severe. 3 infants were mildly affected with haemolytic disease due to the maternal autoantibodies crossing the placenta but no treatment was needed. The risks to the infant were increased when other active autoimmune conditions (e.g., systemic lupus erythematosus) were present. With early diagnosis and appropriate treatment, the outlook for mother and child is good.

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Section: Discussionmentioning

confidence: 99%

Erythrocyte Autoantibodies, Autoimmune Haemolysis and Pregnancy

Sokol¹,

Hewitt²,

Stamps³

1982

Vox Sanguinis

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“…Assessment of reports of AIHA in pregnancy published over the past 50 yr is di&cult, particularly for the 1920-45 pre-antiglobulin test era, because evidence for the autoimmune basis of haemolysis is often incomplete. W e have assembled 19 pregnancies occurring in 16 mothers, requiring in each instance that there be unequivocal evidence for acquired haemolysis and wherever possible serologic confirmation of autoimmunity or evidence of a response to corticosteroid therapy (Bateman et al, 1959;Bromberg et al, 1948;Burt & Prichard, 1957;Craig & Turner, 1955;Frumin et al, 1953;Jankelowitz et al, 1960;Mallarm6 et a!, 1965;Osler, 1919;Priofsky, 1969;Quinlivan & Goldberg, 1967;Seip, 1960;Soderhjelm, 1959;Swisher, 1966;Wagner & Maresch, 1955;Wirtheimer, 1956;Witts & Manch, 1932).…”

Section: Previous Reports Of Aiha In Pregnancymentioning

confidence: 99%

Pregnancy and Idiopathic Autoimmune Haemolytic Anaemia: A Prospective Study during 6 Months Gestation and 3 Months Post‐Partum

et al. 1973

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A 31-yr-old woman with a 12 yr history of relapsing idiopathic autoimmune haemolytic anaemia was studied prospectively during her first pregnancy. Her serum contained a warm incomplete autoantibody as well as an elevated cold agglutinin; her red blood cells were strongly coated with IgG and complement (chiefly a2D). Haemolysis was active throughout pregnancy, accelerating from the 34th to 40th week, with developing thrombocytopenia. Amniocentesis in the 8th and 9th months suggested minimal foetal haemolysis. The maternal haemolytic process went into complete clinical remission following delivery of a healthy appearing infant whose red cells were coated with IgG. The infant developed mild hyperbilirubinaemia within 48 hr and experienced a fall in haemoglobin to 50% of the cord level by the 8th week. Abnormalities of maternal and infant C4 levels were observed. Review of 19 reported instances of presumed autoimmune haemolysis during pregnancy revealed life-threatening anaemia in nearly 50% of mothers, with four still-births, one neonatal death, and three seriously affected infants. A programme for prospective management of this serious clinical problem is discussed.Acquired autoimmune haemolytic anaemia (AIHA) is not a rare haematologic disorder; 20-30 patients with this illness are treated annually at the Washington University Medical Center. Approximately 30% of our cases are 'idiopathic'; of these, one-fourth occur in women in the child-bearing second to fifth decades (Allgood& Chaplin, 1967). It is surprising, therefore, that a search of the literature for the past 50 years reveals only 19 reports of pregnancy in patients with presumed AIHA. Among these, seven mothers exhibited a positive direct antiglobulin test; two of these delivered stillborn infants at 6 months gestation, a third infant developed severe anaemia requiring transfusions at 2 mth of age. In none of the reports were the serological findings in mothers and infants characterized in detail or followed in a systematic sequential manner.Recently, a 31-yr-old patient who had been followed by one of the authors (H.C.) for

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“…Solitary cases have been reported by Bjorsson et al [2] and others [3,5,6,8,10]. It appears that no more than two scores of cases exist in the literature.…”

Section: Discussionmentioning

confidence: 91%

“…A small number of patients have, however, been reported in whom hemolytic anemia occurred during pregnancy, resolved spontaneously after delivery and reoccurred during subsequent pregnancies [2,3,5,6,8,9]. Undoubtedly pregnancy is etiologically related to hemolytic activity in these cases, as hemolysis occurred only during pregnancy and was invariably preceded and followed by hematological normalcy during the nongravid state.…”

Section: Introductionmentioning

confidence: 84%

Pregnancy induced hemolytic anemia: an unexplained entity

Kumar

Sharan

et al. 2001

Annals of Hematology

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We present the case of a young primigravida who developed severe life threatening hemolytic anemia in the last trimester of three successive pregnancies with spontaneous recovery after each delivery and remained normal during the entire nongravid state. Corticosteroid and high-dose intravenous immunoglobulin therapy, although reported as useful, was ineffective in our case. She was managed only with the support with top-up blood transfusions. Extensive investigations were carried out to determine the cause of hemolysis, but these proved unfruitful. Fewer than two scores of such cases have been described in the literature. The paucity of such cases merits its presentation. It is suggested that this anemia should be referred to as "pregnancy-induced hemolytic anemia."

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A Case of Symptomatic Haemolytic Anaemia in Pregnancy

Cited by 18 publications

References 5 publications

Erythrocyte Autoantibodies, Autoimmune Haemolysis and Pregnancy

Erythrocyte Autoantibodies, Autoimmune Haemolysis and Pregnancy

Pregnancy and Idiopathic Autoimmune Haemolytic Anaemia: A Prospective Study during 6 Months Gestation and 3 Months Post‐Partum

Pregnancy induced hemolytic anemia: an unexplained entity

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