Isolierter Haptoglobinabfall in der Schwangerschaft: Zufallsbefund oder pathologisch? - Diskutiert anhand eines Fallberichtes -

Abstract

Haptoglobin is an acute-phase-protein, which is important in many diseases like infections, trauma and neoplasma. An increase in haptoglobin is induced by cytocines like IL-6 und IL-1. The normal range for plasmatic haptoglobin is 50-220 mg/dl. During pregnancy the most likely diagnosis is the HELLP- Syndrome (hemolysis, elevated liver enzymes and low platelets), followed by rare diagnoses like viral hepatitis or favism. We report about a 31-year-old III-gravida 0-para at 31 weeks of gestation with a decrease of haptoglobin over a period of 6 weeks (cut off: < 13 mg/dl) and without any clinical signs of preeclampsia. Liver enzymes were constantly slightly elevated without any progress, other laboratory test results were normal. The patient had a caesarean section at 37 weeks of gestation. Serum haptoglobin returned to normal values within three days after delivery. The reason for the decrease of haptoglobin in our case remains uncertain. Further studies need to focus on the differential diagnosis of a decrease of haptoglobin as well as an isolated decrease of haptoglobin during pregnancy and on the valid ranges of the different haptoglobin subtypes.

Successful Pregnancies During Ongoing Eculizumab Therapy in Two Patients With Complement-Mediated Thrombotic Microangiopathy

“…During her second pregnancy, the dosing frequency of eculizumab was increased during week 17 of gestation because of the previous abortion and low haptoglobin serum concentrations, which might indicate subclinical hemolysis in the absence of other signs of microangiopathic hemolysis. Of note, low haptoglobin serum concentrations were reported in normal pregnancies in the absence of hemolysis 17 , 18 and thus may not inform ongoing hemolysis in a pregnant patient with a history of cTMA. Overall, pregnancy and delivery outcomes in our 2 patients were better as compared with the 3 patients reported by Servais et al.…”