Pure red-cell aplasia secondary to pregnancy, characterization of a syndrome

Abstract

The aim of this study was to characterize the syndrome of pure red-cell aplasia (PRCA) secondary to pregnancy. All published cases of PRCA induced by pregnancy were reviewed. Additionally, we reported a patient who developed PRCA on three occasions; two were triggered by pregnancy and one after medroxyprogesterone administration. Ten patients with 13 pregnancy-induced PRCA episodes were reported. The PRCA occurred at any gestational age. All patients received blood transfusions, and six of them were treated corticosteroids. The PRCA resolved in all subjects postpartum. Five women had subsequent pregnancies; three were complicated by PRCA, one was normal, and one had spontaneous abortion without PRCA. One subject developed a PRCA after long-term exposure to medroxyprogesterone. Infant blood values were normal in the nine reported cases. Pregnancy-induced PRCA is a self-limited syndrome with a high risk for relapse during subsequent pregnancies. It can be managed by blood transfusions. Progestins might cause PRCA in these women.

Immune-mediated pure red cell aplasia in a domestic ferret

“…7,22 In humans, pregnancy has also been associated with immune-mediated PRCA. 23 Acquired autoimmune-mediated mechanisms are thought to be the main process for PRCA in cats, dogs, and humans because antibodies destroy erythroid precursors in the bone marrow. 7,8 Antinuclear antibody titers were evaluated in this ferret, and results were negative; it was the only screening test available (in addition to the slide agglutination test) that could be used to assess autoimmune hemolytic diseases in ferrets.…”

“…Interestingly, 1 form of immune-mediated PRCA in humans is associated with pregnancy. 23 The pathogenesis of PRCA during pregnancy in humans is largely unknown. It has been suggested that hormonal disturbances can cause anemia through direct effects on red cell precursors or by induction of autoimmunity.…”

Recurrent Pregnancy-Related Pure Red Cell Aplasia Responsive To Combined Corticosteroid And Azathioprine Therapy: A Management Dilemma

“…PRCA in pregnancy has a better prognosis compared to pre-existing PRCA and aplastic anemia in pregnancy. In general, PRCA that develops during pregnancy spontaneously resolves postpartum [ 8 ]. Although it rarely recurs in subsequent pregnancy, recurrence was observed here and hence the permanence of PRCA is not known [ 3 ].…”

Aplasia eritroide pura secundaria a embarazo: reporte de un caso y revisión de la literatura

“…Se hace síntesis narrativa de los hallazgos. diez estudios relacionados con anemia aplásica eritroide pura asociada a embarazo: seis reportes de casos (4,7-11,) tres reportes de caso con revisión de la literatura (6,12,13), un reporte de caso en la modalidad de poster (5), para un total de 10 casos reportados (tabla 1).…”

“…Se ha propuesto que las progestinas juegan un papel en la génesis, de tal forma que los cambios hormonales durante el embarazo desencadenan un mecanismo autoinmune en pacientes predispuestas que lleva a inhibición de colonias eritroides, lo que sugiere una respuesta autoinmune humoral (4-5), y la presencia en la sangre periférica de la madre y células placentarias de un factor inhibidor que afecta la eritropoyesis y diferenciación eritroide (6). El diagnóstico de la AEP en el embrazo es por descarte y los hallazgos de la biopsia de médula ósea y la recuperación de los niveles de hemoglobina en pocas semanas posteriores al parto soporta aún más el diagnóstico (6). El tratamiento estaría basado en múltiples transfusiones de hemoderivados durante su periodo gestacional para mantener los niveles de hemoglobina, con riesgo de reacciones secundarias.…”