PURPOSE:

To describe the successful management of a patient with preexisting aplastic anemia by Cesarean section.

Clinical features:

A 31-yr-old female patient with a hypoplastic myelodysplastic syndrome diagnosed six years back presented in this hospital was admitted with signs of pre-eclampsia (blood pressure of 140/90 mmHg, heavy proteinuria and moderate bilateral ankle edema), gum bleeding, and intrauterine growth restriction (IUGR) at 37 weeks amenorrhoea. Laboratory studies revealed pancytopenia (hemoglobin 6.4 g·dL–1, white cell count 2.7x 109·L–1, platelet count 10 x 109·L–1). Ultrasonography, however showed 35 week gestation with moderate IUGR. Patient had premature onset of labour and a Cesarean delivery was performed at 35 weeks with prophylactic platelet transfusion and meticulous blood pressure control. The procedure was uneventful, conducted under general anesthesia with an estimated blood loss of around 400 mL and a live female baby was delivered. Postoperatively her gum bleeding, pancytopenia improved but thrombocytopenia remained at discharge in spite of several units of platelet transfusion.

CONCLUSIONS:

Hypoplastic anemia is rare in pregnancy and it is risky for both mother and fetus. The mother is at risk of aggravated nature of disease because of poor control, life-threatening episodes of bleeding and infection. A multidisciplinary team approach (obstetrician, anesthesiologist, hematologist, and pediatrician) is essential. While accurate assessment and close monitoring of the hematological condition should be made, it is very difficult to correct abnormalities before surgery. Emergent cesarean section proved to be life saving in this case.

Keywords: Aplastic anaemia, cesarean section, thrombocytopenia