A Case Report of Pregnant Woman with Aplastic Anemia: Diagnosis and Management through Subsequent Pregnancy

Introduction: Aplastic anemia is characterized by decreased bone marrow function with inadequate production of erythrocytes, granulocytes, and platelets. Marrow failure may be caused by absence of or defects in hematopoietic stem cells, abnormalities of the bone marrow microenvironment, or immune disorders. There are no clear guidelines for the management of aplastic anemia during pregnancy.

We report a case of pregnant woman in whom anemia was evaluated and diagnosed as Aplastic anemia, managed through the pregnancy and followed her up until subsequent pregnancy with good outcome.

Case: A 19 year teenage girl, primigravida at 36 weeks of gestation presented to our hospital complaining with generalized weakness since 1 month during her antenatal check up. She was evaluated wherein Hb-5.8g/dL, platelet count 11,000, peripheral smear – Megalocytic Anemia with Leucopenia and Thrombocytopenia and no other abnormal cells, was managed conservatively. She had underwent Vaccum assisted vaginal delivery and was third stage of labor was uneventful without any post partum hemorrhage or other bleeding manifestations. During post-partum period, she developed severe anemia and thrombocytopenia with HB-5g/dL, platetlet count of 21,000 and so bone marrow aspiration was done, found to have hypocellular marrow with atypical lymphoid cells, bone marrow biopsy showed hypocellular marrow with decrease in all 3 hematopoietic cell lines, few lymphoid cells with hyper chromatic nucleus and scant eosinophilic cytoplasm, few megakaryocytes. CMV IgM, IgG were found to be positive, ANC was 150 cells /ml and the diagnosis of severe aplastic anemia was confirmed. As her sister was HLA identical sibling, donor stem cell transplantation was performed. She conceived spontaneously, in this subsequent pregnancy had uneventful antenatal, intrapartum and post partum period, delivered live term baby.

Conclusion: Women with severe anemia and thrombocytopenia are to be thoroughly evaluated so as to make timely diagnosis of the disease.