TY - JOUR
T1 - AUTOIMMUNE HEMOLYTIC ANEMIA DURING PREGNANCY AND PUERPERIUM
T2 - AN INTERNATIONAL MULTI-CENTER EXPERIENCE
AU - Fattizzo, Bruno
AU - Bortolotti, Marta
AU - Fantini, Norma Nadia
AU - Glenthøj, Andreas
AU - Michel, Marc
AU - Napolitano, Mariasanta
AU - Raso, Simona
AU - Chen, Frederick
AU - McDonald, Vickie
AU - Murakhovskaya, Irina
AU - Vos, Josephine M I
AU - Patriarca, Andrea
AU - Mingot-Castellano, Maria Eva
AU - Giordano, Giulio
AU - Scarrone, Margherita
AU - Gonzalez-Lopez, Tomas Jose
AU - Trespidi, Laura
AU - Prati, Daniele
AU - Barcellini, Wilma
N1 - Copyright © 2023 American Society of Hematology.
PY - 2023/4/20
Y1 - 2023/4/20
N2 - Relapsing or occurring de novo autoimmune hemolytic anemia (AIHA) during pregnancy or puerperium is a poorly described condition. Here, we report 45 pregnancies in 33 women evaluated at 12 centers from 1997 to 2022. Among the 20 women diagnosed with AIHA before pregnancy, 10 had a relapse. An additional 13 patients developed de novo AIHA during gestation/puerperium (2 patients had AIHA relapse during a second pregnancy). Among 24 hemolytic events, anemia was uniformly severe (median Hb, 6.4 g/dL; range, 3.1-8.7) and required treatment in all cases (96% steroids ± intravenous immunoglobulin, IVIG, 58% transfusions). Response was achieved in all patients and was complete in 65% of the cases. Antithrombotic prophylaxis was administered to 8 patients (33%). After delivery, rituximab was administered to 4 patients, and cyclosporine was added to 1 patient. The rate of maternal complications, including premature rupture of membranes, placental detachment, and preeclampsia, was 15%. Early miscarriages occurred in 13% of the pregnancies. Fetal adverse events (22% of cases) included respiratory distress, fetal growth restriction, preterm birth, AIHA of the newborn, and 2 perinatal deaths. In conclusion, the occurrence of AIHA does not preclude the ability to carry out a healthy pregnancy, provided close monitoring, prompt therapy, and awareness of potential maternal and fetal complications.
AB - Relapsing or occurring de novo autoimmune hemolytic anemia (AIHA) during pregnancy or puerperium is a poorly described condition. Here, we report 45 pregnancies in 33 women evaluated at 12 centers from 1997 to 2022. Among the 20 women diagnosed with AIHA before pregnancy, 10 had a relapse. An additional 13 patients developed de novo AIHA during gestation/puerperium (2 patients had AIHA relapse during a second pregnancy). Among 24 hemolytic events, anemia was uniformly severe (median Hb, 6.4 g/dL; range, 3.1-8.7) and required treatment in all cases (96% steroids ± intravenous immunoglobulin, IVIG, 58% transfusions). Response was achieved in all patients and was complete in 65% of the cases. Antithrombotic prophylaxis was administered to 8 patients (33%). After delivery, rituximab was administered to 4 patients, and cyclosporine was added to 1 patient. The rate of maternal complications, including premature rupture of membranes, placental detachment, and preeclampsia, was 15%. Early miscarriages occurred in 13% of the pregnancies. Fetal adverse events (22% of cases) included respiratory distress, fetal growth restriction, preterm birth, AIHA of the newborn, and 2 perinatal deaths. In conclusion, the occurrence of AIHA does not preclude the ability to carry out a healthy pregnancy, provided close monitoring, prompt therapy, and awareness of potential maternal and fetal complications.
KW - Anemia, Hemolytic, Autoimmune/epidemiology
KW - Female
KW - Humans
KW - Immunoglobulins, Intravenous/therapeutic use
KW - Infant, Newborn
KW - Placenta
KW - Postpartum Period
KW - Pregnancy
KW - Premature Birth/drug therapy
KW - Rituximab/therapeutic use
U2 - 10.1182/blood.2022018890
DO - 10.1182/blood.2022018890
M3 - Journal article
C2 - 36706358
SN - 0006-4971
VL - 141
SP - 2016
EP - 2021
JO - Blood
JF - Blood
IS - 16
ER -