Pregnancy-associated aplastic anemia: a case-based review

Jaime‐Pérez, José Carlos; González-Treviño, Mariana; Gómez‐Almaguer, David

doi:10.1080/17474086.2021.1875816

Cited by 3 publications

(6 citation statements)

References 43 publications

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“…Vaginal delivery is preferred over cesarean delivery at appropriate platelet levels of > 20 × 10 9 /L and > 50 × 10 9 /L, respectively [ 15 ]. The risk of spinal epidural hematoma with a platelet count > 70 × 10 9 /L is very low; however, the decision to proceed with regional anesthesia is at the digression of the anesthesiologist and hospital protocol [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Importance of the Third Trimester Complete Blood Count: A Case Report on Aplastic Anemia in Pregnancy

Pozzo¹,

Kouba²,

Goldman³

et al. 2023

J Hematol

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Aplastic anemia (AA) poses a significant threat to maternal and fetal health throughout the perinatal period. Diagnosis is based on complete blood count (CBC) and bone marrow biopsy with treatment varying based on severity of disease. This report highlights a case of AA incidentally identified by the third trimester CBC drawn in the outpatient office. Patient was referred for inpatient management to mobilize a multidisciplinary team of healthcare professionals including obstetricians, hematologists, and anesthesiologists to optimize maternal and fetal outcome. The patient received blood and platelet transfusions prior to delivering a healthy liveborn infant by cesarean section. This case highlights the importance for routine third trimester CBC screening to identify potential complications and decrease maternal and fetal morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Importance of the Third Trimester Complete Blood Count: A Case Report on Aplastic Anemia in Pregnancy

Pozzo¹,

Kouba²,

Goldman³

et al. 2023

J Hematol

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“…The disease's underlying process involves the inability of haematopoietic stem cells to evolve into mature blood cells, leading to pancytopenia and an absence of bone marrow [ 1 ]. Whilst the specific reasons behind AA in pregnancy are yet to be fully deciphered, it is suggested that the immune changes associated with pregnancy might contribute to the onset or worsening of the condition [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Diagnosing and treating AA in pregnant females are particularly challenging due to symptoms that may mimic normal pregnancy alterations, such as anaemia and low platelet counts [9][10][11]. Additionally, establishing an effective treatment regimen for pregnant AA patients is complicated by the condition's rarity and the potential dangers posed by standard therapies used in nonpregnant individuals [12].…”

Section: Introductionmentioning

confidence: 99%

Aplastic Anaemia in Pregnancy: A Case-Based Comprehensive Review of the Literature

Perolla,

Cela,

Semanaj

et al. 2024

Cureus

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Aplastic anaemia (AA) is a rare and life-threatening haematologic disorder characterised by pancytopenia and bone marrow failure. Its occurrence during pregnancy is exceedingly rare, posing significant risks and management challenges for both the mother and the foetus. We present here the case of a 23-year-old female, six months pregnant, diagnosed with severe aplastic anaemia (AA), aiming to highlight the diagnostic challenges and management considerations of AA in pregnancy. Our case underscores the critical nature of considering aplastic anaemia in differential diagnosis for pregnant patients presenting with unexplained pancytopenia. Based on that, we performed a comprehensive literature review of the past 20 years of papers published in the English language identified through searches in PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase and the Cochrane Library, to provide an in-depth analysis of the current understanding of AA in pregnancy. We emphasise the necessity for cautious yet thorough investigation in such cases to avoid complications in both maternal and foetal health, focusing attention on the need for further research into safe and effective treatment protocols for managing AA in pregnancy, given the complexities introduced by the condition and its treatment on pregnancy outcomes.

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“…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.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

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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Pregnancy-associated aplastic anemia: a case-based review

Cited by 3 publications

References 43 publications

Importance of the Third Trimester Complete Blood Count: A Case Report on Aplastic Anemia in Pregnancy

Importance of the Third Trimester Complete Blood Count: A Case Report on Aplastic Anemia in Pregnancy

Aplastic Anaemia in Pregnancy: A Case-Based Comprehensive Review of the Literature

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

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