Aplastic anemia in two consecutive pregnancies: obstetric an
Aplastic anemia is a serious condition occasionally coexisting with pregnancy. This pathological process is associated with significant maternal and neonatal morbidity and mortality. Obstetric and anesthetic management are particularly challenging, and treatment requires knowledge of pathophysiologic mechanisms in order to provide safe care to this group of patients.

Published in the International Journal of Obstetric Anesthesia, the authors describe the successful obstetric management and labor analgesia of a patient with a diagnosis of aplastic anemia in two consecutive pregnancies.

• Aplastic anemia is a serious condition occasionally coexisting with pregnancy

• Obstetric and anesthetic management are challenging requiring an interdisciplinary approach

• Conservative transfusion management is critical to prevent alloimmunization

• No threshold platelet count for neuraxial anesthesia has been established

• Anesthetic technique must be evaluated on a case-by-case basis.

A 22-year-old patient, who had two prior pregnancies (one spontaneous abortion and one living child), presented to the high-risk obstetric service in 2014 at 24 weeks’ gestation. The patient had a complex medical history, characterized by an episode of what appeared to be a self-limited hepatitis during treatment with isoniazid for a positive tuberculosis skin test four years prior.

One year later the patient developed an episode of fulminant hepatitis diagnosed with liver biopsy. Infectious and autoimmune causes were ruled out and the etiology was unclear (isoniazid versus idiopathic). She received treatment with steroids and intravenous immunoglobulin. After a full clinical recovery, the patient returned two years later with a clinical picture of herpes zoster. During her workup, pancytopenia was diagnosed. At that time, her platelet count was 20 × 109/L, white cell count was 3 × 109/L and hemoglobin was 10.7 g/dL.

Read about the case in detail here: https://www.obstetanesthesia.com/article/S0959-289X(17)30270-4/fulltext