Prognostic aspects of aplastic anemia in pregnancy

Abstract

Our resent experience on six cases of aplastic anemia complicated with pregnancy is described. In addition, 43 similar cases were collected from the literature and reviewed to analyze some prognostic aspects of this relatively rare but potentially serious complication. Clinical and hematological data were treated to extract some clinically meaningful factors in relation to the success and failure of pregnancy. Among initial hematological parameters, no significant difference was found between successful and unsuccessful cases with an exception of hemoglobin concentration. The patients diagnosed as aplastic anemia prior to conception demonstrated an better outcome of pregnancy as well as survival rate of mother when compared with those diagnosed during pregnancy. Mortality has apparently improved after the late 1950's. Success rate of pregnancy before 1958 was 21%, while it was 67% and 71% in the era of 1959-1969 and after 1970, respectively. However, hemorrhage and infection remained to be two major causes of maternal death in both eras. Based on these observations, the currently recommendable attitude to this complication is discussed.

Association of Severe Thrombocytopenia and Poor Prognosis in Pregnancies with Aplastic Anemia

“…It has been suggested that the outcome of pregnancy and maternal survival were better in women who had AA before pregnancy as compared to those in whom it developed during pregnancy [8], [20]. However, our study demonstrated that there are no differences between the 2 groups with regards to severity and postpartum condition.…”

“…Deka argued that maternal and fetal outcome is poor in severe AA [16]. On the contrary, Suda reported no hematologic differences between successful and unsuccessful groups [8]. Those results are conflicting not only because they involved small sample sizes, but also because they applied the same prognostic factor as overall AA without special consideration of pregnancy.…”

“…Several case reports of pregnancy associated with AA have been reported [4]–[8]. It has been suggested that pregnancy is associated with AA, in that aplasia may recover spontaneously after abortion or delivery [9]–[11], and preexisting marrow insufficiency may be aggravated during pregnancy [12]–[13].…”

Fetal and maternal uteroplacental leucocytes in aplastic anaemia. Case report

“…Aplastic anaemia occurring in pregnancy is an uncommon event. Although previously associated with an extremely poor prognosis (Fleming 1973), cases reported since 1970 have been associated with an overall maternal survival of 80% (Suda et al 1978). The survival rates, however, are proportional to the severity of the aplasia.…”

Schwere aplastische Anämie und Schwangerschaft

“…Die aplastische Anämie als klinische Entität wurde erstmals 1888 von Ehrlich beschrieben, bemerkenswerterweise ebenfalls bei einer Schwangeren (6). Seither sind die Meinungen darüber geteilt, ob eine kausale Beziehung zwischen Schwangerschaft und aplastischer Anämie besteht oder ob es sich dabei nur um eine zufällige Koinzidenz handelt (5,7,11,14). Für eine kausale Beziehung sprechen Einzelbeobachtungen, bei denen sich nach Beendigung der Schwanger-schaft das Blutbild wieder normalisierte (10,11).…”