Thrombocytopenia in Pregnancy: Could It Be Acute Leukemia?

Year 2013, Volume: 13 Issue: 2, 103 - 105, 11.03.2014

Yaşam Akpak Nuri Kaya İsmet Gün Vedat Atay

Abstract

The prevalence of pregnancy associated acute leukemia is approximately 1 case out of 100,000 pregnancies. Acute myeloid leukemia (AML) requiring cytotoxic treatment occurring during pregnancy poses a very inconvenient therapeutic dilemma. First of all, AML in pregnancy should be managed between the haematologist and the obstetrician with full involvement of the mother. Chemotherapy should be avoided if possible in the first trimester, because it is associated with a high risk of fetal malformation. The possibility to terminate the pregnancy should be discussed with the family. If termination is refused and the mother’s life is at risk, chemotherapy should be started immediately. Chemotherapy treatment during the second or third trimester may not require termination of pregnancy, because of the remission of AML and delivery of a normal infant is likely to be obtained. Thrombocytopenia in a pregnant women may result from a number of diverse etiologies. While some of these are not associated with adverse pregnancy outcomes, others like leukemias are associated with substantial maternal and/or neonatal morbidity and mortality. In this study, we present a case who had a 27 weeks of gestation complicated with AML, in light of the literature. When the delivery was being planned by the request of the family, fetus died in utero suddenly. Following the birth, induction was performed with the combination of idarubicin and arabinoside. Despite the combined chemotherapy, the patient died one month later. In this case report, we aimed to emphasize some findings like thrombocytopenia and the importance of early chemotherapy in pregnancy for the chance of life for the mother and baby

Keywords

Acute Myeloid Leukemia, thrombocytopenia, fetal, malformation

Gebelikte Trombositopeni; Akut Lösemi Olabilir mi?

Abstract

Özet: Gebelikte izlenen akut löseminin prevalansı yaklaşık 1/100.000’dir. Akut myeloid lösemi (AML) gebelik sırasında tereddütler yaratan sitotoksik bir tedavi gerektirmektedir. Öncelikle gebelikte izlenen AML, annenin tam katılımıyla beraber hematolog ve obstetrisyen tarafından tedavi edilmelidir. İlk trimesterde kemoterapiden, yüksek fetal malformasyon riski sebebiyle, mümkünse kaçınılmalıdır. Gebeliğin sonlandırılması fikri aileyle tartışılmalıdır. Eğer sonlandırma kabul edilmezse ve annenin hayatı tehlikedeyse, kemoterapiye hemen başlanılmalıdır. İkinci trimesterde verilen kemoterapi sırasında, AML’nin remisyona girmesi ve sağlıklı infantların doğması daha sık izlendiği için sonlandırma gerekmez. Pek çok etiyolojik neden gebelikte trombositopeniye neden olabilir. Bunlardan bir çoğu olumsuz gebelik sonuçlarıyla ilişkili olmasa da, lösemiler gibi bazıları maternal ve/veya neonatal morbidite ve mortaliteyle ilişkilidir. Bu çalışmada 27. gebelik haftasında AML tanısı almış bir olguyu literatür ışığında sunduk. Ailenin isteği üzerine doğum planlanırken fetüs anne karnında ani olarak kaybedildi. Doğumdan sonra, idarubisin ve arabinozid kombinasyonu ile kemoterapi uygulandı. Hasta, kombine kemoterapiye rağmen, bir ay sonra kaybedildi. Biz bu vaka sunumunda, anne ve bebeğin yaşam şansı için gebelikte izlenen trombositopeni gibi bazı bulguların ve erken başlanan kemoterapi tedavisinin önemini vurgulamayı amaçladık.

Keywords

Akut Myeloid Lösemi, trombositopeni, fetal, malformasyon

References

• Hass JF. Pregnancy in association with a newly diagnosed cancer: a population based epidemiological assessment. Int J Cancer 1984; 34: 229-5.
• Dilek I, Topcu N, Demir C, Bay A, Uzun K, Gul A, et al. Hematological malignancy and pregnancy: a singleinstitution experience of 21 cases. Clin Lab Haematol 2006; 28(3): 170-6.
• Cardonick E, Iacobucci A. Use of chemotherapy during human pregnancy. Lancet Oncol 2004; 5(5): 283-91.
• Reynoso EE, Shepherd FA, Messner HA, Farquharson HA, Garvey MB, Baker MA. Acute leukemia during pregnancy: the Toronto Study Group experience with long-term followup of children exposed in utero to chemotherapeutic agents. J Clin Oncol 1987; 5: 1098-106.
• Aviles A, Neri N. Hematological malignancies and pregnancy: a final report of 84 children who received chemotherapy in utero. Clin Lymphoma 2001; 2: 173-7.
• Yealez MW, Buckley JD, Woods WG, Ruccione K, Robison LL. History of maternal fetal loss and increased risk of childhood acute leukemia at an early age. Cancer 1995; 75: 1718-27.
• Buekers TE, Lallas TA. Chemotherapy in pregnancy. Obstet Gynecol Clin North Am 1998; 25: 323-9.
• Jacobs C, Donaldson SS, Rosenberg SA, Kaplan HS. Management of the pregnant patient with Hodgkin’s disease. Ann Intern Med 1981; 95: 669-75.
• Antunes de Mayolo JA, Ahn YS, Temple JD, Harrington WJ. Spontaneous remission of acute leukemia after the termination of pregnancy. Cancer 1989; 63: 1621-3.
• Milligan DW, Grimwade D, Cullis JO, Bond L, Swirsky D, Craddock C, et al. Guidelines on the management of acute myeloid leukaemia in adults. Br J Haematol 2006; 135(4): 450Ali R, Ozkalemkaş F, Ozçelik T, Ozkocaman V, Ozan U, Kimya Y, et al. Maternal and fetal outcomes in pregnancy complicated with acute leukemia: a single institutional experience with 12 pregnancies at 16 years. Leuk Res 2003; 27(5): 381-5.
• El-Hemaidi I, Robinson SE. Management of haematological malignancy in pregnancy. Best Pract Res Clin Obstet Gynaecol 2012; 26(1): 149-60.
• Zuazu J, Julia A, Sierra J, , Valentin MG, Coma A, Sanz MA, et al. Pregnancy outcome in hematolgic malignancies. Cancer 1991; 67: 703-9.
• Einarson A, Shuhaiber S, Koren G. Effects of antibacterials on the unborn child: what is known and how should this influence prescribing. Paediatr Drugs 2001; 3: 803-16.
• Ganzitti L, Fachechi G, Driul L, Marchesoni D. Acute promyelocytic leukemia during pregnancy. Fertil Steril 2010; 94(6): 2330 e5-6.
• Sanz MA, Lo Coco F. Standard practice and controversial issues in front-line therapy of acute promyelocytic leukemia. Haematologica 2005; 90(6): 840-5.
• McCrae KR. Thrombocytopenia in pregnancy: differential diagnosis, pathogenesis, and management. Blood Rev 2003; 17: 7-14.
• Yazışma Adresi / Correspondence: Yaşam Kemal AKPAK Sarıkamış Asker Hastanesi e-posta: [e-mail]