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Chapter-09 Aplastic Anemia in Pregnancy

BOOK TITLE: Anemia in Pregnancy

Author
1. Singh Abha
2. Parakh Varsha
ISBN
9788184482997
DOI
10.5005/jp/books/10044_9
Edition
1/e
Publishing Year
2008
Pages
26
Author Affiliations
1. Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital, New Delhi, India
2. Lady Hardinge Medical College and SSK Hospital, New Delhi
Chapter keywords

Abstract

Aplastic anemia is characterized by peripheral pancytopenia and marrow hypoplasia. Pregnancy with aplastic anemia is very rare and has high maternal and fetal morbidity and mortality. The etiology of aplastic anemia is idiopathic while pathogenesis is multifactorial. The disease is insidious in onset and the symptoms are related to decrease in the production of hemopoietic cells. Physical signs result from anemia, neutropenia and thrombocytopenia. Diagnosis is confirmed by bone marrow examination. The International aplastic anemia study group classified the disease into three groups depending upon the severity. In severe aplastic anemia bone marrow cellularity is <25% or 25 to 50% with < 30% residual hemopoietic cells and any two of the following: neutrophils < 0.5 × 109/l, platelets < 20 × 109/l and reticulocytes < 1%. The criteria for Very severe Aplastic anemia are same as that of severe Aplastic anemia except a neutrophil count of <0.2 × 109/l. Patients not fulfilling the criteria for severe or very severe Aplastic anemia fall into non severe Aplastic anemia. One-third of the patients have spontaneous improvement after delivery. Fetal complications may be intrauterine growth restriction, intrauterine death, fetal thrombocytopenia and fetal malformations. Management depends upon gestational age, severity of the disease and treatment given earlier. Identification and elimination of the exposure to causative agents, supportive care to accelerate recovery from pancytopenia should be considered which include prevention and treatment of infections, blood transfusion and psychological and general support. Preferred route of delivery is vaginal but if straining and stress during labor can lead to intracranial hemorrhage or uncontrollable external blood loss then cesarean section with enough units of blood in hand is advisable. Survival rate for mother and baby have increased from 43 and 36% to 81% and 76% respectively with advances in treatment.

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