Maruyama H, Shimada H, Obayashi H, Nakamaru T, Miyakawa Y, Goto S, Ogihara T, Takakuwa K, Tanaka K, Kishimoto H, Yuasa Y, Sakai S, Okajima H, Suzuki S, Arakawa M
Department of Medicine II, Niigata University School of Medicine, Niigata, Japan.
Nephron. 1998 Aug;79(4):413-9. doi: 10.1159/000045086.
BACKGROUND/AIMS: Pregnancy in hemodialysis (HD) patients tends to be diagnosed late because of its infrequency and the lack of validity of urine pregnancy tests, and because these patients tend to have menstrual irregularities. The outcome is influenced by pregnancy-related anemia. We investigated the characteristics of pregnancy-related anemia and whether it is a useful diagnostic clue to pregnancy in HD patients.
We retrospectively investigated six pregnancies of 5 HD patients (mean age 30 years), including 4 patients treated with recombinant human erythropoietin (rHuEpo) and a transfusion-dependent patient with two pregnancies in the pre-rHuEpo era.
The mean duration of HD was 6 years, the mean duration of the patients' marriages at the time of pregnancy was 6 years, and the mean gestational age at diagnosis was 11 weeks and 4 days. The progression of anemia (an 8% decrease in the hematocrit) was detected by 8 weeks of gestation in all patients. The prepregnancy hematocrit was stable in 5 pregnancies, facilitating the detection of changes, but during one of the pregnancies of the transfusion-dependent patient the hematocrit was low and was influenced by the transfusions. The amount of rHuEpo required to attain a target hematocrit of 30% increased gradually or rapidly until delivery.
The progression of anemia or hyporesponsiveness to rHuEpo was a useful early diagnostic clue to pregnancy in HD patients. However, the prepregnancy hematocrit should be stabilized with rHuEpo, so that decreases can be easily detected. The precise mechanisms of hyporesponsiveness to rHuEpo, which progressed during pregnancy and subsided after delivery, remain to be clarified.
背景/目的：血液透析（HD）患者怀孕往往因发生率低、尿妊娠试验无效以及这些患者往往存在月经不调而诊断较晚。其结局受妊娠相关贫血的影响。我们调查了妊娠相关贫血的特征以及它是否是HD患者妊娠的有用诊断线索。
我们回顾性研究了5例HD患者（平均年龄30岁）的6次妊娠，其中包括4例接受重组人促红细胞生成素（rHuEpo）治疗的患者以及1例在rHuEpo时代前有两次妊娠的输血依赖患者。
HD的平均持续时间为6年，患者怀孕时的平均婚姻持续时间为6年，诊断时的平均孕周为11周零4天。所有患者在妊娠8周时均检测到贫血进展（血细胞比容下降8%）。5次妊娠的孕前血细胞比容稳定，便于检测变化，但输血依赖患者的一次妊娠期间血细胞比容较低且受输血影响。达到目标血细胞比容30%所需的rHuEpo量在分娩前逐渐或迅速增加。
贫血进展或对rHuEpo反应性降低是HD患者妊娠的有用早期诊断线索。然而，应使用rHuEpo使孕前血细胞比容稳定，以便易于检测到下降。妊娠期间进展且分娩后消退的对rHuEpo反应性降低的确切机制仍有待阐明。
