Riveros-Perez Efrain, Hermesch Amy C, Barbour Linda A, Hawkins Joy L
Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, GA.
Maternal Fetal Medicine.
Int J Womens Health. 2018 Feb 28;10:117-125. doi: 10.2147/IJWH.S149683. eCollection 2018.
Aplastic anemia is a hematologic condition occasionally presenting during pregnancy. This pathological process is associated with significant maternal and neonatal morbidity and mortality. Obstetric and anesthetic management is challenging, and treatment requires a coordinated effort by an interdisciplinary team, in order to provide safe care to these patients. In this review, we describe the current state of the literature as it applies to the complexity of aplastic anemia in pregnancy, focusing on pathophysiologic aspects of the disease in pregnancy, as well as relevant obstetric and anesthetic considerations necessary to treat this challenging problem. A multidisciplinary-team approach to the management of aplastic anemia in pregnancy is necessary to coordinate prenatal care, optimize maternofetal outcomes, and plan peripartum interventions. Conservative transfusion management is critical to prevent alloimmunization. Although a safe threshold-platelet count for neuraxial anesthesia has not been established, selection of anesthetic technique must be evaluated on a case-to-case basis.
再生障碍性贫血是一种偶尔在孕期出现的血液学疾病。这一病理过程与孕产妇和新生儿的高发病率及死亡率相关。产科和麻醉管理具有挑战性，治疗需要多学科团队的协同努力，以便为这些患者提供安全的护理。在本综述中，我们描述了适用于孕期再生障碍性贫血复杂性的当前文献状况，重点关注孕期该疾病的病理生理方面，以及治疗这一具有挑战性问题所需的相关产科和麻醉注意事项。采用多学科团队方法管理孕期再生障碍性贫血对于协调产前护理、优化母婴结局以及规划围产期干预措施是必要的。保守的输血管理对于预防同种免疫至关重要。虽然尚未确定神经轴索麻醉的安全血小板计数阈值，但必须根据具体情况评估麻醉技术的选择。
