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Case Report



Aplastic anemia in pregnancy: a rare case report

Vineet Mishra, Priyankur Roy, Bhumika Vyas, Rohina Aggarwal, Sumesh Choudhary, Neha Mehta.

Abstract
Aplastic anemia is a rare disease caused by destruction of pluripotent stem cells in bone marrow. During pregnancy it could be life-threatening for both mother and child. The only causal therapy for aplastic anemia is bone marrow transplantation, which is contraindicated during pregnancy because of potential embryo toxicity. Treatment options are erythrocytes and platelet transfusions and immunosuppressive therapy. A 26-year-old multiparous woman was referred to our hospital with low-grade fever. She had undergone bone marrow biopsy elsewhere, which confirmed the diagnosis of aplastic anemia. Routine laboratory tests at admission showed pancytopenia (hemoglobin – 3.5gm/dl, total leukocyte count – 400/cmm and platelet count – 20,000/cmm). She was transfused multiple units of packed cell volume, random donor platelets and single donor platelets. At 31 weeks she went into spontaneous labour and gave birth to a preterm female child who succumbed on 3rd post-natal day. After delivery the blood count of the patient did not recover and she did not respond to medication. In spite optimal supportive treatment, she died on her eighth post-natal day. This potential life-threatening disease has a relatively poor prognosis for the mother and a comparatively good prognosis for the baby. Transfusion during pregnancy is the first choice treatment with recommended hemoglobin levels of more than 8.0gm/dl and platelet count of more than 20,000/cmm. Cyclosporine A seems a reasonable alternative therapy with a reported success rate in non-pregnant patients of 70%. Our patient was not treated with immunosuppressive agents as she already had neutropenia with worsening infection.

Key words: Aplastic anemia, Immunosuppressive Therapy, Platelet transfusion, Pregnancy


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