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Prognostic aspects of aplastic anemia in pregnancy

Experience on six cases and review of the literature

Prognostische Aspekte der aplastischen Anämie in der Schwangerschaft

Bericht über sechs derartige Fälle unter Bezugnahme auf die Literatur

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Zusammenfassung

Berichte über Schwangerschaften bei aplastischer Anämie oder das Auftreten einer aplastischen Anämie in der Schwangerschaft sind selten. Anhand von 6 eigenen derartigen Fällen und von 43 Fällen aus der Literatur wurden die hämatologischen und klinischen Befunde in Hinsicht auf ihre prognostische Bedeutung untersucht.

Bei den hämatologischen Parametern war lediglich die Hämoglobinkonzentration von prognostischer Bedeutung. Bei Auftreten der aplastischen Anämie vor der Schwangerschaft war die Prognose besser als bei Auftreten während der Schwangerschaft. Der Prozentsatz der erfolgreich ausgetragenen Schwangerschaften stieg von 21% vor 1958 auf 67% in der Zeit von 1959 bis 1969 und auf 71% nach 1970. Blutungen und Infektionen waren die beiden wichtigsten mütterlichen Todesursachen. Aus den Ergebnissen ist abzuleiten, daß bei ausgeprägtem Kinderwunsch und gutem Allgemeinzustand von einer Schwangerschaft bei bestehender aplastischer Anämie nicht immer abgeraten werden muß und daß andererseits bei einer progredienten aplastischen Anämie, die in der Schwangerschaft auftritt, möglichst früh eine Schwangerschafts-unterbrechung erfolgen muß.

Summary

Our recent experience on six cases of aplastic anemia complicated with pregnancy is described. In addition, 43 similar cases were collected from the literature and reviewed to analyze some prognostic aspects of this relatively rare but potentially serious complication. Clinical and hematological data were treated to extract some clinically meaningful factors in relation to the success and failure of pregnancy.

Among initial hematological parameters, no significant difference was found between successful and unsuccessful cases with an exception of hemoglobin concentration. The patients diagnosed as aplastic anemia prior to conception demonstrated an better outcome of pregnancy as well as survival rate of mother when compared with those diagnosed during pregnancy. Mortality has apparently improved after the late 1950's. Success rate of pregnancy before 1958 was 21% while it was 67% and 71% in the era of 1959–1969 and after 1970, respectively. However, hemorrhage and infection remained to be two major causes of maternal death in both eras.

Based on these observations, the currently recommendable attitude to this complication is discussed.

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References

  1. Akasaka, K., Takahashi, Y., Doi, Y.: A successfully and normally delivered case of aplastic anemia complicating pregnancy. Acta Haemat. Jap.33, 713 (1970)

    Google Scholar 

  2. Asano, T., Kunisada, M., Yamamoto, T., Tanaka, S.: A successful case of aplastic anemia complicating pregnancy. Jap. Soc. Intern. Med.58, 660–661 (1969)

    Google Scholar 

  3. Bigby, M.A.W., Jones, F.A.: A case of aplastic anemia in pregnancy. J. Obst. Gynaec. Brit. Emp.53, 182–184 (1946)

    Google Scholar 

  4. Boria, P.: Hémopathies et grossesse. A propos d'un observation. Annales de Biologie Clinique7, 22 (1949) (Cited from No. 56)

    Google Scholar 

  5. Browaeys, J., Pley, J.: Hématologie d'un prémature agranulocytose maternelle. Le Sang.21, 826–829 (1950)

    PubMed  Google Scholar 

  6. Collins, D.J., Rosenthal, D.S., Goldstein, D.R., Moloney, F., Moloney, W.C.: Aplastic anemia in pregnancy. Obstet. Gynec.39, 884–886 (1972)

    PubMed  Google Scholar 

  7. Dilworth, E.E., Mays, C.R.: Clinical and hematologie aplastic anemia with hypercellular marrow in pregnancy. Am. J. Obst. Gynec.54, 529–532 (1947)

    Google Scholar 

  8. Dobriner, K., Rhoads, C.P., Hummel, L.E.: The excretion of porphyrin in refractory and aplastic anemia. J. Clin. Invest.17, 125–132 (1938)

    Google Scholar 

  9. Dorgan, L.T., McGaughey, H.S.: Aplastic anemia complicating pregnancy. Am. J. Obstet. Gynec.61, 1390–1392 (1951)

    PubMed  Google Scholar 

  10. Eguchi, H., Fujimori, H.: A case of aplastic anemia detected by routine check up of pregnancy. Sanfujinka-Chiryo25, 87–92 (1972)

    Google Scholar 

  11. Ehrlich, P.: Über einen Fall von Anämie mit Bemerkungen über regenerative Veränderungen des Knochenmarks. Charité-Ann.13, 300–309 (1888)

    Google Scholar 

  12. Emmrich, J.P.: Aplastische Anämie und Schwangerschaft. Zbl. Gynäk.12, 1320–1323 (1947)

    Google Scholar 

  13. Erslev, A.J.: Erythrocyte disorders-Aplastic anemia. In: Hematology. Williams, J.W. et al. (eds.) p. 207. New York: McGraw-Hill 1972

    Google Scholar 

  14. Evans, I.L.: Aplastic anemia in pregnancy remitting after abortion. Brit. Med. J.20, 166–167 (1968)

    Google Scholar 

  15. Figge, D.C., Donohue, D.M., Alvarez, R.R.: Aplastic anaemia in pregnancy. J. Obst. Gynec.67, 994–950 (1960)

    Google Scholar 

  16. Fleming, A.F.: Hypoplastic anaemia in pregnancy. J. Obstet. Gynaec. Brit.Cwlth.75, 138–141 (1968)

    Google Scholar 

  17. Fleming, A.F.: Hypoplastic anaemia in pregnancy. Clin. Haemat.2, 477–496 (1973)

    Google Scholar 

  18. Föderl, V.: Zur Differentialdiagnose und Therapie der Schwangerschafts-Anämien. Wien. Klin. Wschr.51, 168 (1938) (Cited from No. 56)

    Google Scholar 

  19. Györy, V.G., Kiss, C.S.: Über einen Fall von primärer aplastischer Schwangerschaftsanämie. Zbl. Gynäk.87, 942–951 (1965)

    Google Scholar 

  20. Havard, C.W.H., Scott, R.B.: Refractory anaemia. A disease or a syndrome. LancetI, 461–464 (1963)

    Google Scholar 

  21. Held, S.G.: Aplastische Anämie und Schwangerschaft. Gynaecologia122, 265–268 (1946)

    Google Scholar 

  22. Hibino, S.: Aplastic anemia-especially related to incidence. Jap. J. Clin. Hemat.16, 299–304 (1975)

    Google Scholar 

  23. Higo, S., Hayakawa, T., Isobe, H., Amaki, K., Inoue, K., Abe, T.: A review; Aplastic anemia and pregnancy. Jap. J. Clin. Hemat.8, 425–431 (1967)

    Google Scholar 

  24. Hirschfeld, H.: Über schwere Anämien ohne Regeneration des Knochenmarks. Berl. Klin. Wschr.43, 545–548 (1906)

    Google Scholar 

  25. Holly, R.G.: Hypoplastic anemia in pregnancy. Obst. Gynec.1, 535–543 (1953)

    Google Scholar 

  26. Hurwitt, E.S., Field, L.: Aplastic anemia in pregnancy. Am. J. Obstet. Gynec.43, 42–51 (1942)

    Google Scholar 

  27. Iwanaga, T., Fujimura, K., Nagata, Y., Amaki, K.: A successful case of aplastic anemia in pregnancy. Jap. J. Clin. Hemat.10, 186–187 (1969)

    Google Scholar 

  28. Iwasaki, S., Chin, T., Itazu, Y., Yamada, K., Sakai, M., Koide, T.: A case of aplastic anemia who experienced three deliveries. Jap. J. Clin. Hemat.11, 553 (1970)

    Google Scholar 

  29. Kageyama, T., Kimoto, S., Funagoshi, K., Sugiyama, S., Tsumoto, S.: Aplastic anemia and labor. Bull. Osaka Med. School.21, 19–27 (1975)

    Google Scholar 

  30. King, T.M., Todd, W.D.: Aplastic anemia in pregnancy. Sloane Hosp. Worn.10, 42–47 (1964)

    Google Scholar 

  31. Knispel, J.W., Lynch, V.A., Viele, B.D.: Aplastic anemia in pregnancy; A case report, review of the literature and a reevaluation of management. Obstet. Gynec. Surv.31, 523–528 (1976)

    Google Scholar 

  32. Koda, K., Onishi, S., Kageyama, M., Nishizima, H.: A case of aplastic anemia complicating pregnancy. Sanka-to-Fujinka36, 809–813 (1969)

    Google Scholar 

  33. Kyser, F.A., Danforth, D.N.: Reversible refractory anemia in pregnancy. J.A.M.A.174, 485–488 (1960)

    PubMed  Google Scholar 

  34. Lachmann, A., Lund, E., Vinther-Paulsen, N.: Severe refractory anemia in pregnancy. Acta Obstet. Gynec. Scand.33, 395–404 (1954)

    PubMed  Google Scholar 

  35. Larrabee, R. C.: The severe anemias of pregnancy and the puerperium. Am. J. Med. Sci.170, 371–389 (1925)

    Google Scholar 

  36. Lennard-Jones, J.E., DeHeese, H. V., Venn, R. J.: Aplastic anemia during pregnancy. J. Obstet. Gynaec. Brit. Emp.64, 92–94 (1958)

    Google Scholar 

  37. Loring, T.W.: Aplastic anemia during pregnancy. Stanford Med. Bull.11, 170–172 (1953)

    PubMed  Google Scholar 

  38. Maizels, G.: Aplastic anemia of pregnancy with recovery. S. Afr. med. J.25, 973–974 (1951)

    PubMed  Google Scholar 

  39. Massary, M., Well, M.P.: Anémie pernicieuse aplastique chez un primipare. Bull, et mêm. Soc. Méd. Hôp. de Paris25, 872–877 (1908)

    Google Scholar 

  40. Matsui, T., Miura, K., Jo, K.: An experience of delivery in a patient with aplastic anemia. Sanfujinka Chiryo20, 355–359 (1970)

    Google Scholar 

  41. Messerschmitt, P.J.: Les aplasies médullaires au cours de la grossesse. Nouv. Rev. Franç. Hémat.12, 15–28 (1972)

    Google Scholar 

  42. Meren, A., Sugenuma, H., Yamaya, T.: A case of aplastic anemia with normal full-term pregnancy. Acta haemat. jap.33, 712–713 (1970)

    Google Scholar 

  43. Murakami, F.: On hemostatic measures for the thrombocytopenic states in Gynecologic and obstetric field. Sanfujinka Chiryo19, 842–852 (1969)

    Google Scholar 

  44. Murakawa, E., Fujimiya, M.: A case of aplastic anemia complicating pregnancy. Jap. J. Clin. Hemat.13, 1040–1041 (1972)

    Google Scholar 

  45. Nagai, K.: A case of aplastic anemia with an onset during pregnancy. Rinsho-no-Nippon11, 787–794 (1943)

    Google Scholar 

  46. Nakayama, S., Torihama, Y., Sugiyama, Y., Hoshino, T.: Pregnancy, delivery and aplastic anemia with special reference to hematological remission following delivery. Jap. J. Clin. Hemat.14, 659–667 (1973)

    Google Scholar 

  47. Nemoto, T., Tanaka, T., Kaji, H., Hoshiai, H., Kimura, Y.: Delivery of a case with aplastic anemia. Jap. J. Clin. Med.17, 1838–1843 (1959)

    Google Scholar 

  48. Niewenhuis, G.: Case of aplastic anemia during pregnancy. Nederl. T. Verlosk.82, 2126–2134 (1938) (Cited from No. 56)

    Google Scholar 

  49. Noma, K., Takagi, A.: A case of aplastic anemia complicated with pregnancy. Rinsho Fujinka-Sanka8, 719–721 (1954)

    Google Scholar 

  50. Obata, E.: A case of aplastic anemia complicating pregnancy and severe hemorrhagic diathesis. Nippon Fujinka Gakkai Zasshi43, 14 (1948)

    Google Scholar 

  51. Okamoto, K., Shinagawa, H., Yamamoto, K.: A successful case of aplastic anemia with eclampsia. Acta haemat. jap.23, 898–899 (1960)

    Google Scholar 

  52. Oram, R.H., Mills, A.E., Thomas, J.E.P.: Primary aplastic anemia in pregnancy. S. Afr. med. J.46, 1738–1740 (1972)

    PubMed  Google Scholar 

  53. Ota, Y., Kitazima, K., Kozuka, A., Rokuguruma, M.: Cases of leukemia and aplastic anemia complicating pregnancy. Jap. J. Clin. Hemat.6, 95 (1965)

    Google Scholar 

  54. Pannke, H.: Schwangerschafts- und Geburtenverlauf bei Panmyelophthise (aplastischer Anämie). Zbl. Gynäk.74, 1219–1225 (1952)

    Google Scholar 

  55. Rosner, F., Sussmann, S.N.: Aplastic anemia in pregnancy. Obstet. Gynec.23, 99–103 (1964)

    PubMed  Google Scholar 

  56. Rovinsky, J.J.: Primary refractory anemia complicating pregnancy and delivery. Obstet, gynec. Surv.14, 149–170 (1959)

    Google Scholar 

  57. Saito, T.: A case of aplastic anemia complicating pregnancy. Nippon Sanka-Fujinka Gakkai Zasshi4, 1032–1034 (1952)

    Google Scholar 

  58. Sanhenza, H.: Bol. Clin. Obstet, Chile32 (1931) (Cited from No. 56)

    Google Scholar 

  59. Satake, M., Kinjo, N.: Delivery in a patient with aplastic anemia. Sanfujinka-no-Sekai23, 977–980 (1971)

    Google Scholar 

  60. Satoi, S., Sato, N.: A case of aplastic anemia complicating pregnancy. Nippon Sanka-Fujink Gakkai Tokyo Kaiho2, 76 (1953)

    Google Scholar 

  61. Sugiyama, Y., Torihama, Y., Nakayama, S.: A case of aplastic anemia with prolonge remission after caesarean section. Sanfujinka-no-Sekai25, 157–160 (1973)

    Google Scholar 

  62. Suzuki, M., Goto, S., Hasegawa, K., Fushibuchi, D., Handou, T., Mizuguchi, K.: A cas of aplastic anemia with two deliveries. Sanka-to-Fujinka34, 952–956 (1967)

    Google Scholar 

  63. Taylor, J. J., Studd, J.W.W., Green, I.D.: Primary refractory anemia and pregnancy. J Obstet. Gynaec. Brit. Comm.75, 963–968 (1968)

    Google Scholar 

  64. Tenenbaum, M.J., Warner, J.F.: Aplastic anemia in pregnancy; Recovery after normal spontaneous delivery. Ann. Int. Med.82, 537–543 (1975)

    Google Scholar 

  65. Torigoe, T., Wada, H., Sugi, N., Tsuchie, H., Goto, M.: Three cases of aplastic anemia. Rinsho Fujinka-Sanka21, 906–910 (1967)

    Google Scholar 

  66. Turunen, A.: Beiträge zur Kenntnis der bösartigen Schwangerschaftsanämien. Acta Soc. Med. fenn. duodecim., Ser. B, fasc. 3,30, 24–49 (1941)

    Google Scholar 

  67. Yagita, H.: Aplastic anemia in pregnancy improved after termination. Acta haemat. jap. (Kyushu District)2, 116–117 (1951)

    Google Scholar 

  68. Yamada, K., Sekiya, C., Sato, F., Watanabe, T., Ueda, N., Kawauchi, H., Shibata, F.: An autopsy case of aplastic anemia complicating pregnancy with leukoerythroblastic blood picture. Jap. J. Clin. Hemat.10, 749–750 (1969)

    Google Scholar 

  69. Yoshikawa, B., Ichihara, M., Kodera, Y., Shimokata, K., Haga, K.: Two cases of aplastic anemia complicating pregnancy. Jap. J. Clin. Hemat.12, 121 (1971)

    Google Scholar 

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  1. The Third Department of Medicine, Gunma University School of Medicine, 3-39-15 Showa-Machi, 371, Maebashi Gunma, Japan

    T. Suda, M. Omine, J. Tsuchiya & T. Maekawa

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Suda, T., Omine, M., Tsuchiya, J. et al. Prognostic aspects of aplastic anemia in pregnancy. Blut 36, 285–298 (1978). https://doi.org/10.1007/BF01880679

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