ABSTRACT
Background: Acute Lymphoblastic leukaemia (ALL) is a malignant disorder which originates in a single B–or T-lymphocytes progenitor as a result of somatic mutation. ALL represents about 15% of all malignancies in 1-15 year olds, 5% in 15-19 year olds, and <10% of malignancy in >20 year olds. This condition is rare in pregnancy and when it occurs, its management and the use of chemotherapy during pregnancy, poses a significant risk to both the mother and fetus. Aim: To underscore the difficult dilemma physicians are faced with in the management of ALL in pregnancy. Study Design: Case study. Place of Study: Obstetrics & Gynaecology Department of the Federal Medical Centre, Bida, Nigeria. Methods: A review of the index case was conducted at the Obstetrics & Gynaecology Department of the Federal Medical Centre, Bida-a tertiary health care facility in Nigeria. This review took into cognizance the patient’s demographic bio-data, case history, methods of diagnosis and various supportive measures. A comprehensive analysis and account of events during this period were also reviewed. Results: This case identifies a 26-year old gravida 2, para 1+0, a full term housewife and secondary school leaver, a Muslim background from a tribe of the Nupe part of Niger State. She was on a routine antenatal visit to Obstetrics Unit, when patient was noticed to have purpuric lesions. She was subsequently referred to our unit (Haematology Department) at a gestational age of 22 weeks 4 days along with florid features of bleeding diathesis. A complete blood count, cytochemical, Immunophenotyping and molecular analysis done classified patient as having a Ph Negative, pre B acute lymphoblastic leukaemia in pregnancy. Patient was then offered some supportive measures though inadequate due to the absence of aphaeretic machine in the centre. Patient had early uneventful spontaneous vaginal delivery of a live baby (birth weight; 2.6kg) at 30 weeks gestation thereby making administration of chemotherapy much less worrisome. Meanwhile, mother and baby remain clinically stable while being followed up on the aftermath of remission induction of combination chemotherapy. Conclusion: Supportive management for ALL patients with anaemia and thrombocytopaenia is a necessary pre-induction workup step, and as in this case, would allow room for fetal growth and lung maturity; when the fetus would be mature enough to cope with extra-uterine life but also without endangering the health of the mother. This patient however, had early spontaneous vaginal delivery precluding the anticipated risk of fetal exposure to cytotoxic agents.
ABSTRACT
OBJECTIVE: Pregnancy-associated aplastic anemia remains a rare occurrence. The aim of this study was to examine the maternal and fetal outcomes of pregnancy-associated aplastic anemia treated with supportive care. METHODS: From January 1995 to December 2004, a total of 14 women newly diagnosed with pregnancy-associated aplastic anemia were recruited for the study. RESULTS: Eleven (78%) of the 14 women were diagnosed with pregnancy-associated aplastic anemia during the second or third trimester. There were eight severe cases; three of which were diagnosed at the initial presentation. All 14 women had conservative management with transfusions but not specific immunological or hormonal therapies during pregnancy. Blood transfusions were performed prenatally in seven mothers and perinatally in 13. Of the 12 patients eligible for follow-up, one achieved complete remission and another eight showed partial remission after delivery. During the follow up period, there was no case of maternal-fetal death in our series. The pregnancies were continued uneventfully in most cases. CONCLUSIONS: This study demonstrated favorable maternal and neonatal outcomes with transfusion support alone for pregnancy-associated aplastic anemia. Therefore, pregnancy continuation with meticulous blood support should be considered, rather than therapeutic termination, for women with pregnancy-associated aplastic anemia.