Korean J Obstet Gynecol.  2012 Oct;55(10):745-750.

Pregnancy complicated with myelodysplastic syndrome and severe preeclampsia: A case report

• Park HG
• Yoon SY
• Choi SJ
• Oh SY
• Kim JH
• Roh CR

Abstract

Myelodysplastic syndrome (MDS) is characterized by pancytopenia in the peripheral blood due to ineffective hematopoiesis in the bone marrow. Even though pregnancy complicated with MDS is extremely rare, it can be associated with a risk of bleeding or infection during pregnancy. Therefore, meticulous supportive care including proper transfusion of packed red blood cell or platelet concentrate and decision of timing of delivery should be provided. In this report, we present a pregnancy complicated with MDS and severe preeclampsia simultaneously with a brief review of literatures.

Keyword

Myelodysplastic syndrome; Preeclampsia; Pregnancy

MeSH Terms

Blood Platelets
Bone Marrow
Erythrocytes
Hematopoiesis
Hemorrhage
Myelodysplastic Syndromes
Pancytopenia
Pre-Eclampsia
Pregnancy

Figure

• 

  Fig. 1 Peripheral blood smear showing macrocytic and hyperchromic anemia (cross), hypersegmented neutrophil (arrow) and moderate thrombocytopenia (Wright-Giemsa stain, ×1,000).

• 

  Fig. 2 Umbilical artery Doppler velocimetry at 27 weeks 2 days of gestation. Velocimetry is zero during diastole.

• 

  Fig. 3 The changes of blood cell count during pregnancy and postpartum period. (A) Platelet. (B) White blood cell (WBC). (C) Hemoglobin (Hb). C/Sec, Cesarean delivery; POD, postoperation day.

Reference

1. Rizack T, Mega A, Legare R, Castillo J. Management of hematological malignancies during pregnancy. Am J Hematol. 2009. 84:830–841.

2. Gidiri M, Masson EA, Ali S, Freites J, Carter C, Lindow SW. Myelodysplasia diagnosed during pregnancy with temporary haematological improvement after delivery. J Obstet Gynaecol. 2009. 29:665–667.

3. Kim JY, Cho JH, Chang SW, Kim HC, Kang SH, Cho HJ, et al. Acute leukemia and myelodysplasitc syndrome during pregnancy a single institutional experience of 4 cases. Korean J Obstet Gynecol. 2003. 46:1037–1042.

4. McCrae KR. Thrombocytopenia in pregnancy. Hematology Am Soc Hematol Educ Program. 2010. 2010:397–402.

5. Young BC, Levine RJ, Karumanchi SA. Pathogenesis of preeclampsia. Annu Rev Pathol. 2010. 5:173–192.

6. Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR, et al. Proposals for the classification of the myelodysplastic syndromes. Br J Haematol. 1982. 51:189–199.

7. Siddiqui T, Elfenbein GJ, Noyes WD, Moreb JS, Oblon D, Weiner RS. Myelodysplastic syndromes presenting in pregnancy. A report of five cases and the clinical outcome. Cancer. 1990. 66:377–381.

8. Steensma DP, Tefferi A. Myelodysplastic syndrome and pregnancy: the Mayo Clinic experience. Leuk Lymphoma. 2001. 42:1229–1234.

9. Fadilah SA, Roswati MN. Refractory anaemia with excess of blasts in transformation (RAEB-T) during pregnancy with haematological remission following delivery. Br J Haematol. 1999. 104:935–936.

10. Shim GJ, Wang L, Andersson S, Nagy N, Kis LL, Zhang Q, et al. Disruption of the estrogen receptor beta gene in mice causes myeloproliferative disease resembling chronic myeloid leukemia with lymphoid blast crisis. Proc Natl Acad Sci U S A. 2003. 100:6694–6699.

11. Ikeda Y, Masuzaki H, Nakayama D, Maeda T, Newaz Khan K, Okita Y, et al. Successful management and perinatal outcome of pregnancy complicated with myelodysplastic syndrome. Leuk Res. 2002. 26:255–260.

12. Frenkel EP, Yardley DA. Clinical and laboratory features and sequelae of deficiency of folic acid (folate) and vitamin B12 (cobalamin) in pregnancy and gynecology. Hematol Oncol Clin North Am. 2000. 14:1079–1100.

13. Duerbeck NB, Chaffin DG, Coney P. Platelet and hemorrhagic disorders associated with pregnancy: a review. Part I. Obstet Gynecol Surv. 1997. 52:575–584.

14. Vlădăreanu AM, Vasilache V, Bumbea H, Onisâi M. Platelet dysfunction in acute leukemias and myelodysplastic syndromes. Rom J Intern Med. 2011. 49:93–96.

15. Kaufmann SJ, Sharif K, Sharma V, McVerry BA. Term delivery in a woman with severe congenital neutropenia, treated with growth colony stimulating factor. Hum Reprod. 1998. 13:498–499.