TY - JOUR

T1 - Autoimmune hemolytic anemia during pregnancy and puerperium

T2 - an international multicenter experience

AU - Fattizzo, Bruno

AU - Bortolotti, Marta

AU - Fantini, Norma N.

AU - Glenthøj, Andreas

AU - Michel, Marc

AU - Napolitano, Mariasanta

AU - Raso, Simona

AU - Chen, Frederick

AU - McDonald, Vickie

AU - Murakhovskaya, Irina

AU - Vos, Josephine Mathilde Iris

AU - Patriarca, Andrea

AU - Mingot-Castellano, Maria Eva

AU - Giordano, Giulio

AU - Scarrone, Margherita

AU - González-López, Tomás José

AU - Trespidi, Laura

AU - Prati, Daniele

AU - Barcellini, Wilma

N1 - Funding Information: The open access fees were paid by the Italian Ministry of Health, Current Research Grant. Publisher Copyright: © 2023 The American Society of Hematology

PY - 2023

Y1 - 2023

N2 - Relapsing or occurring de novo autoimmune hemolytic anemia (AIHA) during pregnancy or puerperium is a poorly described condition. Here, we report 45 pregnancies in 33 women evaluated at 12 centers from 1997 to 2022. Among the 20 women diagnosed with AIHA before pregnancy, 10 had a relapse. An additional 13 patients developed de novo AIHA during gestation/puerperium (2 patients had AIHA relapse during a second pregnancy). Among 24 hemolytic events, anemia was uniformly severe (median Hb, 6.4 g/dL; range, 3.1-8.7) and required treatment in all cases (96% steroids ± intravenous immunoglobulin, IVIG, 58% transfusions). Response was achieved in all patients and was complete in 65% of the cases. Antithrombotic prophylaxis was administered to 8 patients (33%). After delivery, rituximab was administered to 4 patients, and cyclosporine was added to 1 patient. The rate of maternal complications, including premature rupture of membranes, placental detachment, and preeclampsia, was 15%. Early miscarriages occurred in 13% of the pregnancies. Fetal adverse events (22% of cases) included respiratory distress, fetal growth restriction, preterm birth, AIHA of the newborn, and 2 perinatal deaths. In conclusion, the occurrence of AIHA does not preclude the ability to carry out a healthy pregnancy, provided close monitoring, prompt therapy, and awareness of potential maternal and fetal complications.

AB - Relapsing or occurring de novo autoimmune hemolytic anemia (AIHA) during pregnancy or puerperium is a poorly described condition. Here, we report 45 pregnancies in 33 women evaluated at 12 centers from 1997 to 2022. Among the 20 women diagnosed with AIHA before pregnancy, 10 had a relapse. An additional 13 patients developed de novo AIHA during gestation/puerperium (2 patients had AIHA relapse during a second pregnancy). Among 24 hemolytic events, anemia was uniformly severe (median Hb, 6.4 g/dL; range, 3.1-8.7) and required treatment in all cases (96% steroids ± intravenous immunoglobulin, IVIG, 58% transfusions). Response was achieved in all patients and was complete in 65% of the cases. Antithrombotic prophylaxis was administered to 8 patients (33%). After delivery, rituximab was administered to 4 patients, and cyclosporine was added to 1 patient. The rate of maternal complications, including premature rupture of membranes, placental detachment, and preeclampsia, was 15%. Early miscarriages occurred in 13% of the pregnancies. Fetal adverse events (22% of cases) included respiratory distress, fetal growth restriction, preterm birth, AIHA of the newborn, and 2 perinatal deaths. In conclusion, the occurrence of AIHA does not preclude the ability to carry out a healthy pregnancy, provided close monitoring, prompt therapy, and awareness of potential maternal and fetal complications.

U2 - 10.1182/blood.2022018890

DO - 10.1182/blood.2022018890

M3 - Journal article

C2 - 36706358

AN - SCOPUS:85150809747

VL - 141

SP - 2016

EP - 2021

JO - Blood

JF - Blood

SN - 0006-4971

IS - 16

ER -