Pregnancy induced hemolytic anemia: an unexplained entity

Abstract

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."

Pregnancy‐associated haemolytic anaemia: A cause not to be forgotten

“…7 As it typically presents around the third trimester and often remits postpartum one must also consider delivery as a treatment option for severe, refractory cases. 9 In conclusion we present two cases of pregnancy-associated immunemediated haemolytic anaemia. Unlike typical autoimmune haemolytic anaemia our cases had a negative DAT with no other cause found.…”

“…8 Despite extensive investigation the cause of the aberrant antibody production in both cases remained unknown; however, normalisation of serum haptoglobins in response to corticosteroids and delivery suggests a placentally-derived immune or hormonal aetiology. 9…”

“…8 Despite extensive investigation the cause of the aberrant antibody production in both cases remained unknown; however, normalisation of serum haptoglobins in response to corticosteroids and delivery suggests a placentally-derived immune or hormonal aetiology. 9 Typically, the hallmark feature in AIHA is a positive DAT demonstrating the presence of antibodies bound to the red cell surface. Potential causes for a negative DAT include technical errors, use of antisera lacking the corresponding antibody subclass (most polyspecific reagents including those used in these two cases, have little activity against IgA and IgM) and the presence of an antibody that is readily dissociable or easily eluted, insufficient antibodies or homologous destruction of coated red cells.…”

“…Neither woman has gone on to have subsequent pregnancies but if so, it would be advisable to monitor them regularly given the potential risk of recurrence. 9,12…”

“…7 As it typically presents around the third trimester and often remits postpartum one must also consider delivery as a treatment option for severe, refractory cases. 9…”