Archives of Gynecology and Obstetrics

, Volume 288, Issue 2, pp 341–347

Flare up of ulcerative colitis during pregnancy treated by adsorptive granulocyte and monocyte apheresis: therapeutic outcomes in three pregnant patients

  • Hiroki Takahashi
  • Kaori Sugawara
  • Mikako Sugimura
  • Masahiro Iwabuchi
  • Yutaka Mano
  • Katsuaki Ukai
  • Keiichi Tadokoro
General Gynecology



Treatment of ulcerative colitis with drugs during pregnancy potentially may harm the mother and the unborn child. Granulocytapheresis depletes elevated/activated myeloid lineage leucocytes as sources of inflammatory cytokines. We were interested in the safety and efficacy of granulocytapheresis in patients who had ulcerative colitis flare up during pregnancy.


Three pregnant cases with active ulcerative colitis received Adacolumn granulocytapheresis, up to 10 sessions within 3–6 weeks. Case 1: a 33-year-old woman with left-sided colitis and bloody diarrhoea 7–9 times/day showed loss of mucosal vascular patterns, and contact bleeding from the rectum to the sigmoid colon. Case 2: a 36-year-old woman with pancolitis and bloody diarrhoea 6–8 times/day had loss of mucosal vascular patterns and pus from the rectum to the sigmoid colon. Case 3: a 36-year-old woman with pancolitis and diarrhoea 4–5 times/day (first episode) had erosions and pus in the mucosa from the rectum to the transverse colon.


Colitis flare was in weeks 5, 13 and 22 of pregnancy in cases 1, 2, 3, respectively. The corresponding granulocytapheresis sessions were 5, 7, and 10, reflecting an increasing trend with the pregnancy week. Patients 1 and 2 achieved complete remission, patient 3 achieved clinical remission.


In these three cases with active ulcerative colitis during pregnancy, granulocytapheresis as a non-pharmacologic treatment was effective and safe. In case 3 that did not respond well to the initial granulocytapheresis sessions, a moderate dose of prednisolone enhanced the efficacy of granulocytapheresis and tapering of prednisolone shortly after administration was not associated with relapse.


Ulcerative colitis flare up Pregnancy Adsorptive granulocyte and monocyte apheresis Mucosal healing Complete remission 


  1. 1.
    Allison MC, Dhillon AP, Lewis WG (eds) (1998) Inflammatory bowel disease. Londonm, Mosby, pp 15–95Google Scholar
  2. 2.
    Vermeire S, Carbonnel F, Coulie PG et al (2012) Management of inflammatory bowel disease in pregnancy. J Crohns Colitis 6:811–823PubMedCrossRefGoogle Scholar
  3. 3.
    Mahadevan U (2006) Fertility and pregnancy in the patient with inflammatory bowel disease. Gut 55:1198–1206PubMedCrossRefGoogle Scholar
  4. 4.
    Nørgård BM (2011) Birth outcome in women with ulcerative colitis and Crohn’s disease, and pharmacoepidemiological aspects of anti-inflammatory drug therapy. Dan Med Bull 58:B4360PubMedGoogle Scholar
  5. 5.
    Alstead E, Nelson-Piercy C (2003) Inflammatory bowel disease in pregnancy. Gut 52:159–161PubMedCrossRefGoogle Scholar
  6. 6.
    Cornish J, Tan E, Teare J et al (2007) A meta-analysis on the influence of inflammatory bowel disease on pregnancy. Gut 56:830–837PubMedCrossRefGoogle Scholar
  7. 7.
    Mahadevan U, Sandborn WJ, Li DK, Hakimian S, Kane S, Corley DA (2007) Pregnancy outcomes in women with inflammatory bowel disease: a large community-based study from Northern California. Gastroenterology 133:1106–1112PubMedCrossRefGoogle Scholar
  8. 8.
    Dominitz JA, Young JC, Boyko EJ (2002) Outcomes of infants born to mothers with inflammatory bowel disease: a population-based cohort study. Am J Gastroenterol 97:641–648PubMedCrossRefGoogle Scholar
  9. 9.
    Korelitz BI (1998) Inflammatory bowel disease and pregnancy. Gastroenterol Clin North Am 27:213–224PubMedCrossRefGoogle Scholar
  10. 10.
    Mogadam M, Dobbins WO, Korelitz BI, Ahmed SW (1981) Pregnancy in inflammatory bowel disease: effect of sulfasalazine and corticosteroids on fetal outcome. Gastroenterology 80:72–76PubMedGoogle Scholar
  11. 11.
    Gisbert JP (2010) Safety of immunomodulators and biologics for the treatment of inflammatory bowel disease during pregnancy and breast-feeding. Inflamm Bowel Dis 16:881–895PubMedCrossRefGoogle Scholar
  12. 12.
    Brown SL, Greene MH, Gershon SK, Edwards ET, Mraun MM (2002) Tumor necrosis factor antagonist therapy and lymphoma development: twenty-six cases reported to the food and drug administration. Arthritis Rheum 46:3151–3158PubMedCrossRefGoogle Scholar
  13. 13.
    Saniabadi AR, Hanai H, Lofberg R et al (2007) Therapeutic leucocytapheresis for inflammatory bowel disease. Transf Aphere Sci 37:191–200CrossRefGoogle Scholar
  14. 14.
    Hanai H, Takeda Y, Saniabadi AR et al (2011) The mode of actions of the Adacolumn therapeutic leucocytapheresis in patients with inflammatory bowel disease: a concise review. Clin Exp Immunol 163:50–58PubMedCrossRefGoogle Scholar
  15. 15.
    Yamamoto T, Umegae S, Matsumoto K (2012) Long-term clinical impact of early introduction of granulocyte and monocyte adsorptive apheresis in new onset, moderately active, extensive ulcerative colitis. J Crohn’s Colitis 6:750–755Google Scholar
  16. 16.
    Saniabadi AR, Hanai H, Takeuchi K et al (2003) Adacolumn, an adsorptive carrier based granulocyte and monocyte apheresis device for the treatment of inflammatory and refractory disease associated with leukocytes. Ther Apher Dial 2003(7):48–59CrossRefGoogle Scholar
  17. 17.
    Sakuraba A, Motoya S, Watanabe K et al (2009) An open-label prospective randomized multicenter study shows very rapid remission of ulcerative colitis by intensive granulocyte and monocyte adsorptive apheresis as compared with routine weekly treatment. Am J Gastroenterol 104:2990–2995PubMedCrossRefGoogle Scholar
  18. 18.
    Suzuki Y, Yoshimura N, Saniabadi AR, Saito Y (2004) Selective granulocyte and monocyte adsorptive apheresis as a first-line treatment for steroid naïve patients with active ulcerative colitis: a prospective uncontrolled study. Dig Dis Sci 49:565–571PubMedCrossRefGoogle Scholar
  19. 19.
    Domenech E, Hinojosa J, Esteve-Comas M (2004) Spanish group for the study of Crohn’s disease and ulcerative colitis (GETECCU). Granulocyteaphaeresis in steroid-dependent inflammatory bowel disease: a prospective, open, pilot study. Aliment Pharmacol Ther 20:1347–1352PubMedCrossRefGoogle Scholar
  20. 20.
    Caprilli R, D’Ovidio V (2007) Leukocytapheresis as promising therapy for inflammatory bowel disease. Dig Liver Dis 39:435–437PubMedCrossRefGoogle Scholar
  21. 21.
    Sands BE, Sandborn WJ, Feagan B et al (2008) A randomized, double-blind, sham-controlled study of granulocyte/monocyte apheresis for active ulcerative colitis. Gastroenterology 135:400–409PubMedCrossRefGoogle Scholar
  22. 22.
    Lichtiger S, Present DH, Kornbluth A et al (1994) Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 330:1841–1845PubMedCrossRefGoogle Scholar
  23. 23.
    Schroeder KW, Tremaine WJ, Ilstrup DM (1987) Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med 317:1625–1629PubMedCrossRefGoogle Scholar
  24. 24.
    Oron G, Yogev Y, Shkolnik S et al (2012) Inflammatory bowel disease: risk factors for adverse pregnancy outcome and the impact of maternal weight gain. J Matern Fetal Neonatal Med 25:2256–2260PubMedCrossRefGoogle Scholar
  25. 25.
    Suzuki Y, Yoshimora N, Saito Y, Saniabadi A (2006) A retrospective search for predictors of clinical response to selective granulocyte and monocyte apheresis in patients with ulcerative colitis. Dig Dis Sci 51:2031–2038PubMedCrossRefGoogle Scholar
  26. 26.
    Tanaka T, Okanobu H, Yoshimi S et al (2008) Adsorptive depletion of granulocytes and monocytes impacts mucosal level of neutrophils and clinically is most effective in steroid naïve patients. Dig Liver Dis 40:731–736PubMedCrossRefGoogle Scholar
  27. 27.
    Shimoyama T, Sawada K, Hiwatashi N et al (2001) Safety and efficacy of granulocytes and monocyte adsorption apheresis in patients with active ulcerative colitis: a multiple study. J Clin Apher 16:1–9PubMedCrossRefGoogle Scholar
  28. 28.
    Tanaka T, Okanobu H, Kuga Y et al (2010) Clinical and endoscopic features of responders and non-responders to adsorptive leucocytapheresis: a report based on 120 patients with active ulcerative colitis. Gastroenterol Clin Biol 34:687–695PubMedCrossRefGoogle Scholar
  29. 29.
    Kato S, Hosomi E, Amano F et al (2012) The efficacy of intensive granulocyte and monocyte adsorption apheresis in a patient with Crohn’s disease complicated by extensive subcutaneous aseptic neutrophilic abscesses. J Crohns Colitis 6:787–791PubMedCrossRefGoogle Scholar
  30. 30.
    Strobl FJ, Voelkerding KV, Smith EP (1999) Management of chronic myeloid leukemia during pregnancy with leukapheresis. J Clin Apher 14:42–44PubMedCrossRefGoogle Scholar
  31. 31.
    Ali R, Ozkalemkaş F, Ozkocaman V et al (2004) Successful pregnancy and delivery in a patient with chronic myelogenous leukemia (CML), and management of CML with leukapheresis during pregnancy: a case report and review of the literature. Jpn J Clin Oncol 34:215–217PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Hiroki Takahashi
    • 1
  • Kaori Sugawara
    • 1
  • Mikako Sugimura
    • 1
  • Masahiro Iwabuchi
    • 1
  • Yutaka Mano
    • 1
  • Katsuaki Ukai
    • 1
  • Keiichi Tadokoro
    • 1
  1. 1.Department of GastroenterologySendai Medical CenterSendaiJapan

Personalised recommendations