ABSTRACT
Globally, patients living with sickle cell disease are now surviving to reproductive age, with life expectancy approaching 50 years in most countries. Thus, reproductive options are now essential for patients living with the condition. However, it can be associated with maternal, delivery, and fetal complications. Outcomes may vary depending on the level of expertise and resources. In this piece we provide an optional guideline for managing sickle cell disease in pregnancy. The therapeutic option of serial exchange prophylactic transfusion has been offered in the context of a clinical trial (TAPS2).
Subject(s)
Anemia, Sickle Cell , Pregnancy Complications, Hematologic , Pregnancy , Humans , Female , Middle Aged , Pregnancy Complications, Hematologic/therapy , Developed Countries , Anemia, Sickle Cell/therapyABSTRACT
BACKGROUND: Pregnancy seems to increase the risk of thrombotic thrombocytopenic purpura (TTP) relapses and make the TTP more severe in any of the pregnancy trimesters, or even during the postpartum period. CASE PRESENTATION: This study highlights details of treating a COVID-19 pregnant patient who survived. This 21-year addicted White woman was admitted at her 29th week and delivered a stillbirth. She was transferred to another hospital after showing signs of TTP, which was caused by a viral infection. CONCLUSION: This viral infection caused fever and dyspnea, and the patient was tested positive for COVID-19 infection. A chest computed tomography scan showed diffuse multiple bilateral consolidations and interlobar septal thickening. She stayed at the Intensive Care Unit for 20 days and treated with plasmapheresis. As far as we know, this is the first report of a TTP pregnant patient with COVID-19 infection.
Subject(s)
COVID-19/diagnosis , Plasmapheresis , Pregnancy Complications, Hematologic/diagnosis , Pregnancy Complications, Infectious/diagnosis , Purpura, Thrombotic Thrombocytopenic/diagnosis , Stillbirth , Acute Kidney Injury/therapy , Amphetamine-Related Disorders , Antiviral Agents/therapeutic use , COVID-19/therapy , Drug Combinations , Erythrocyte Transfusion , Female , Hemoglobins/metabolism , Humans , Hydroxychloroquine/therapeutic use , Intensive Care Units , L-Lactate Dehydrogenase/metabolism , Lopinavir/therapeutic use , Methamphetamine , Pregnancy , Pregnancy Complications, Hematologic/metabolism , Pregnancy Complications, Hematologic/therapy , Pregnancy Complications, Infectious/metabolism , Pregnancy Complications, Infectious/therapy , Purpura, Thrombotic Thrombocytopenic/metabolism , Purpura, Thrombotic Thrombocytopenic/therapy , Renal Dialysis , Ritonavir/therapeutic use , SARS-CoV-2 , Tomography, X-Ray Computed , Young AdultABSTRACT
Iron deficiency is the commonest cause for anaemia worldwide making it a formidable issue particularly during pregnancy because of increased iron demands. This study looked at establishing a lower limit of normal for haemoglobin concentration (Hb) in our population and to proactively address potentially symptomatic iron deficiency during the current SARS-CoV-2 pandemic. The lower limit of normal for Hb in our 1715 first trimester pregnancy cohort was 116 g/L. This is in contrast with guidance suggesting Hb levels down to 110 g/L are normal. In addition there was evidence of limited testing performed to look for iron deficiency with only 18 % having a serum ferritin checked. Most anaemia was normocytic suggesting that microcytosis is only a late marker of iron deficiency lacking sensitivity. A strategy to avoid hospital contact during the COVID-19 pandemic is proposed.
Subject(s)
Anemia, Iron-Deficiency/therapy , Iron/administration & dosage , Pregnancy Complications, Hematologic/therapy , Administration, Intravenous , Administration, Oral , Anemia, Iron-Deficiency/blood , COVID-19/epidemiology , Female , Ferritins/blood , Humans , Pandemics , Pregnancy , Pregnancy Complications, Hematologic/blood , Retrospective Studies , SARS-CoV-2 , Severity of Illness IndexABSTRACT
We present a putative link between maternal COVID-19 infection in the peripartum period and rapid maternal deterioration with early organ dysfunction and coagulopathy. The current pandemic with SARS-CoV-2 has already resulted in high numbers of critically ill patients and deaths in the non-pregnant population, mainly due to respiratory failure. During viral outbreaks, pregnancy poses a uniquely increased risk to women due to changes to immune function, alongside physiological adaptive alterations, such as increased oxygen consumption and edema of the respiratory tract. The laboratory derangements may be reminiscent of HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, and thus knowledge of the COVID-19 relationship is paramount for appropriate diagnosis and management. In addition to routine measurements of D-dimers, prothrombin time, and platelet count in all patients presenting with COVID-19 as per International Society on Thrombosis and Haemostasis (ISTH) guidance, monitoring of activated partial thromboplastin time (APTT) and fibrinogen levels should be considered in pregnancy, as highlighted in this report. These investigations in SARS-CoV-2-positive pregnant women are vital, as their derangement may signal a more severe COVID-19 infection, and may warrant pre-emptive admission and consideration of delivery to achieve maternal stabilization.