Clinical Mnaifestations, Management and Obstetrical Outcome of the Pregnant Women with Aplastin Anemia

Jun, Jong Kwan; Park, Joong Shin; Yoon, Bo Hyun; Shin, Hee Chul; Kim, En Kyung; Seo, Won Suk; Lee, Bae Hoon; Kim, Joo Chul; Kim, Young Ah

Abstract

BACKGROUND: Aplastic anemia is an uncommon disease characterized by marrow hypocellularity, resulting in a reduction of the counts of circulating red blood cells, neutrophils, and platelets. The etiology of aplastic anemia remains unknown in the majority of cases. An association of aplastic anemia with pregnancy has been reported but the strength of such a relationship remains somewhat controversial.
OBJECTIVE
To evaluate the association of aplastic anemia with pregnancy and the optimal management of patients with aplastic anemia during pregnancy.
METHODS
This retrospective study was done by review of medical records of 18 patients with aplastic anemia, of whom 8 patients were diagnosed before pregnancy and 10 patients were diagnosed during pregnancy, who had a total of 25 pregnancies after the diagnosis from January, 1990 to October, 1997 at the Seoul National University Hospital,
RESULTS
The incidence of aplastic anemia during pregnancy was one in 806 persons(18/14, 507) in this study. During pregnancy, the circulating blood cell levels decreased in all pregnancies. In all 7 cases that showed a relapse during pregnancy the remission occurred following the termination of pregnancy. 12 patients presenting with severe aplastic anemia during pregnancy had poorer hematological improvement than patients with mild aplastic anemia after termination of pregnancy.
CONCLUSION
In all patients with aplastic anemia during pregnancy the circulating blood cell levels decreased. The successful outcome in these cases illustrates the benefit of modern supportive care in the management of such patients. The present observations suggest that a pregnancy which occurs during the long-term remission of aplastic anemia may be allowed to progress to birth.