Aplastic anemia during pregnancy: a review of obstetric and anesthetic considerations

Riveros-Pérez, Efraín; Hermesch, Amy; Barbour, Linda A.; Hawkins, Joy L.

doi:10.2147/ijwh.s149683

Cited by 19 publications

(20 citation statements)

References 91 publications

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“…This was caused by maternal factors which was aplastic anemia. 10,11 Cesarean in our case was indicated due to fetal IUGR although in cases of aplastic anemia, vaginal birth is preferred. As recommended to this patient we make sure that the platelet count was >20x103/μL which acceptable for vaginal delivery and 50x103/μL for cesarean delivery.…”

Section: Discussionmentioning

confidence: 81%

“…Intrauterine growth retardation complicated as one of our cases. 4,[9][10][11] Fetal growth surveillance should be performed by 28 weeks of gestation, and antenatal testing should also be offered by 30-32 weeks, due to the high prevalence of growth restriction. In this case, growth restriction was identifi ed after close monitoring and established by abdominal circumference and estimated fetal weight in 31 weeks gestational age correspond to 1500 g. The asymmetrical IUGR fi nding from the ratio head and abdominal circumference (>1.2) indicated new-onset hypoxia.…”

Section: Discussionmentioning

confidence: 99%

“…As recommended to this patient we make sure that the platelet count was >20x103/μL which acceptable for vaginal delivery and 50x103/μL for cesarean delivery. 10,11…”

Section: Discussionmentioning

confidence: 99%

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Management of Aplastic Anemia in Pregnancy: A Case Report

Djusad

Malano

2020

Indones J Obstet Gynecol

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Aplastic anemia was first recognized by Ehrlich in 1888, although the pathogenesis of aplastic anemia has remained elusive. Aplastic anemia is a subtype of anemia characterized by pancytopenia and a hypocellular bone marrow which are the risk factor can be due to chemicals, drugs, infections, irradiation, leukemia, and inherited disorders. There is universal agreement that pregnancy complicated by aplastic anemia is a serious condition. The risk to the mother is mainly in the form of hemorrhage meanwhile the fetus may suffer from growth restriction and even intrauterine death. Most of the fetal complications are due to maternal anemia. We here present one cases of pregnancy complicated by aplastic anemia, which were seen within 3 months at our hospital. This high incidence is because the hospital is a top national care referral unit with good hematology and blood bank support. Keyword: aplastic anemia, pregnancy, pancytopenia Abstrak Anemia aplastik pertama kali dikenali oleh Ehrlich pada tahun 1888, walaupun patogenesis anemia aplastik masih sulit dipahami. Anemia aplastik adalah subtipe anemia yang ditandai dengan pansitopenia dan hiposeluler sumsum tulang yang merupakan faktor risiko yang dapat disebabkan oleh bahan kimia, obat-obatan, infeksi, iradiasi, leukemia, dan kelainan bawaan. Terdapat kesepakatan universal bahwa komplikasi kehamilan berupa anemia aplastik merupakan kondisi serius. Risiko kepada ibu hamil terutama dalam bentuk perdarahan sementara janin dapat mengalami hambatan dalam pertumbuhan dan bahkan kematian dalam kandungan. Sebagian besar komplikasi janin disebabkan oleh anemia pada maternal. Kami di sini menyajikan satu kasus komplikasi kehamilan berupa anemia aplastik, yang ditemukan dalam waktu 3 bulan di rumah sakit kami. Kejadian yang tinggi ini karena rumah sakit adalah unit rujukan perawatan nasional teratas dengan hematologi yang baik dan dukungan bank darah.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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Management of Aplastic Anemia in Pregnancy: A Case Report

Djusad

Malano

2020

Indones J Obstet Gynecol

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“…Other than postpartum hemorrhage, there are no known obstetrical complications that are specific to pregnancy in women with aplastic anemia. Remarkably, however, previous studies have reported that the rate of pregnancy complications in women with aplastic anemia, including preeclampsia, fetal growth restriction, and preterm delivery, were variable [8,17,18]. Interestingly, infarction in the placenta without fetal growth restriction has been reported previously in cases of ITP that were treated with the thrombopoietin receptor agonist romiplostim during pregnancy [19].…”

Section: Discussionmentioning

confidence: 90%

“…In some cases, women with aplastic anemia experience worsening symptoms or relapse during pregnancy [1,2], and marked thrombocytopenia is often observed with advancing gestation. However, available treatment options during pregnancy are limited; hematopoietic stem-cell transplantation or the use of ATG is generally contraindicated in pregnancy [1,8], and only cyclosporin, whether it is effective or not, is thought to be safe. Ultimately, supportive care with blood products is the mainstay of treatment of aplastic anemia in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Aplastic Anemia Treated with Eltrombopag during Pregnancy

Suminaga

Chigusa

Kondo

et al. 2022

Case Reports in Obstetrics and Gynecology

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Aplastic anemia is a rare blood disorder characterized by pancytopenia and hypocellular bone marrow. In patients with aplastic anemia, pancytopenia sometimes worsens during pregnancy, and relapse of aplastic anemia in pregnancy is common. Nevertheless, only supportive care with blood products is the mainstay of treatment of aplastic anemia in pregnancy. Thus, the obstetric management and treatment of aplastic anemia in pregnancy is extremely challenging. We herein report the first case of a pregnant woman complicated with aplastic anemia who was successfully treated with eltrombopag, a thrombopoietin receptor agonist. A 27-year-old primigravida woman who had a history of aplastic anemia refractory to immunosuppressive therapy and was treated with eltrombopag became pregnant. Eltrombopag treatment was continued after weighing the benefits and potential risks. Throughout pregnancy, the woman’s pancytopenia did not progress, and she delivered a 2336 g baby vaginally at 38 weeks of gestation. Her postpartum outcome was uneventful, and the neonate did not develop thrombocytosis. Since the efficacy and safety of eltrombopag in pregnancy has not yet been established, its routine use should be avoided. However, if limited to refractory cases and with adequate maternal and fetal monitoring, including neonatal blood examinations, the use of eltrombopag for patients with aplastic anemia during pregnancy may be acceptable and result in favorable maternal and fetal outcomes.

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Pregnancy in acquired bone marrow failure syndromes: Antenatal management and maternal and fetal outcomes

Bortolotti,

Trikha,

Salter

et al. 2024

American J Hematol

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Aplastic anemia (AA) is an acquired bone marrow failure (BMF) disorder characterized by hypocellular bone marrow and pancytopenia. The pathogenic mechanism is an immune-mediated attack against hematopoietic precursors, and the concomitant detection of a paroxysmal nocturnal hemoglobinuria (PNH) clone, or its emergence over time, is a frequent event. Pregnancy is one of the proposed risk factors for autoimmune disease development and cases of AA in pregnant women were described in numerous case series. [1][2][3][4][5] However, limited data are available on the management of BMFs during pregnancy or on feto-maternal outcomes.We conducted a single-center retrospective cohort study including women with acquired AA and/or PNH, referred to a tertiary center in the United Kingdom over the last 25 years. The study focused on women who experienced either a relapse of known AA or a de novo occurrence of BMF during pregnancy. Demographic, clinical, and disease severity findings according to Camitta criteria 6 were collected.Additionally, information regarding treatment administered before, during, and after each pregnancy, response to AA-treatment, according to RACE trial adopted criteria, 7 as well as feto-maternal outcomes were systematically recorded.Seventy pregnancies occurring in 52 women were included from a cohort of 266 women with BMF followed from 1989 until 2022; 17 patients developed AA de novo during pregnancy, while 28 had a diagnosis of AA predating pregnancy (Table S1). Additionally, seven patients had a hemolytic PNH (two with onset during pregnancy and five with a previous diagnosis).Regarding 17 de novo AA, most presented during the first trimester, 57% versus 36% and 7% in the second and third trimester respectively, with severe presentation in 29% of cases. In seven patients a PNH clone was detected with a median granulocytes clone of 5.2%(1.7-19). During pregnancy, 16 (94%) required blood transfusions and eight (47%) immunosuppressive therapy (IST) with cyclosporin (CSA) (five patients, three responsive) or steroids (three subjects, one responsive). After delivery, spontaneous hematologic improvement occurred in seven subjects (41%), however, 10 (59%) required IST or transplant (5 ATG + CSA ± Eltrombopag; 4 CSA/Androgens; 1 HSCT) all with response. Maternal adverse events (AEs) were observed in 29% of pregnancies, including two peripartum bleedings, one preterm premature rupture of the membrane (PPROM), and a Cesarean scar infection. Three women needed an urgent Cesarean Section (CS) (one for PPROM, two unknown), and three received additional peripartum transfusion support. No spontaneous miscarriages occurred, but fetal

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Aplastic anemia during pregnancy: a review of obstetric and anesthetic considerations

Cited by 19 publications

References 91 publications

Management of Aplastic Anemia in Pregnancy: A Case Report

Management of Aplastic Anemia in Pregnancy: A Case Report

Aplastic Anemia Treated with Eltrombopag during Pregnancy

Pregnancy in acquired bone marrow failure syndromes: Antenatal management and maternal and fetal outcomes

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