Zhang Chao, Liang Mei-ying, Wang Shan-mi
Department of Obstetrics, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Fu Chan Ke Za Zhi. 2009 Jul;44(7):488-91.
To investigate the diagnosis, management, pregnancy outcome and prognosis of bicytopenia or pancytopenia during pregnancy.
Retrospective chart review was conducted on 24 pregnancies who were found bicytopenia or pancytopenia during pregnancy for the first time. The diagnoses were reconfirmed. The management and pregnancy outcome were collected. And the prognoses were followed.
According to the clinical data and laboratory findings, the latter including complete blood cell count, reticulocyte count, peripheral smear, serum folate and vitamin B12 level, autoimmune antibody screening, bone marrow smear and biopsy, thirteen patients were diagnosed as having chronic aplastic anemia (CAA), six as having myelodysplastic syndromes (MDS), two as having megaloblastic anemia (MA), one as having paroxysmal nocturnal hemoglobinuria (PNH), one as having Evan's syndrome and one as having acute leukemia. The management basically consisted of supportive transfusions. Six patients suffered pregnancy complications including four with severe preeclampsia (one with intracranial hemorrhage and one with intrauterine death concomitantly) and two with gestational diabetes. The delivery ages of the 21 patients were term or nearly term with all good neonatal outcomes. Postpartum follow-up showed the two patients with MA achieved complete remission, the one with PNH had mild anemia and that with Evan's syndrome had mild thrombocytopenia. The patient with acute leukemia died of recurrence six months postpartum. Of the thirteen patients with CAA, two achieved complete remission, six partial remission, four no remission and one was lost follow-up. Of the 6 patients with MDS, one achieved partial remission, four no remission, and one transformed into acute monocytic leukemia, then refused chemotherapy and was lost follow-up.
CAA may be one of the most common causes of bicytopenia or pancytopenia during pregnancy, MDS may be the second. Diagnosis should be made as soon as possible through appropriate and reasonable laboratory examinations. Most patients could achieve good pregnancy outcomes through supportive management. The maternal prognosis may vary widely depending on the causes.
探讨孕期双血细胞减少或全血细胞减少的诊断、处理、妊娠结局及预后。
对首次在孕期发现双血细胞减少或全血细胞减少的24例妊娠患者进行回顾性病历审查。重新确认诊断。收集处理情况及妊娠结局，并对预后进行随访。
根据临床资料及实验室检查结果，后者包括全血细胞计数、网织红细胞计数、外周血涂片、血清叶酸及维生素B12水平、自身抗体筛查、骨髓涂片及活检，13例患者诊断为慢性再生障碍性贫血（CAA），6例为骨髓增生异常综合征（MDS），2例为巨幼细胞贫血（MA），1例为阵发性睡眠性血红蛋白尿（PNH），1例为伊文氏综合征，1例为急性白血病。处理基本包括支持性输血。6例患者出现妊娠并发症，包括4例重度子痫前期（1例伴颅内出血，1例伴宫内死亡）和2例妊娠期糖尿病。21例患者的分娩孕周为足月或近足月，新生儿结局均良好。产后随访显示，2例MA患者完全缓解，1例PNH患者有轻度贫血，1例伊文氏综合征患者有轻度血小板减少。急性白血病患者产后6个月死于复发。13例CAA患者中，2例完全缓解，6例部分缓解，4例未缓解，1例失访。6例MDS患者中，1例部分缓解，4例未缓解，1例转化为急性单核细胞白血病，随后拒绝化疗并失访。
CAA可能是孕期双血细胞减少或全血细胞减少最常见的原因之一，MDS可能次之。应通过适当合理的实验室检查尽早做出诊断。大多数患者通过支持性处理可获得良好的妊娠结局。母亲的预后因病因不同可能差异很大。
