Thrombocytopenia in Pregnancy: Could It Be Acute Leukemia?

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?

Öz

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.

Anahtar Kelimeler

• Akut Myeloid Lösemi
• trombositopeni
• fetal
• malformasyon

Kaynakça

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17. Yazışma Adresi / Correspondence: Yaşam Kemal AKPAK Sarıkamış Asker Hastanesi e-posta: [e-mail]