Autoimmune hemolytic anemia during pregnancy and puerperium: an international multicenter experience

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  • Bruno Fattizzo
  • Marta Bortolotti
  • Norma N. Fantini
  • Glenthøj, Andreas Birkedal
  • Marc Michel
  • Mariasanta Napolitano
  • Simona Raso
  • Frederick Chen
  • Vickie McDonald
  • Irina Murakhovskaya
  • Josephine Mathilde Iris Vos
  • Andrea Patriarca
  • Maria Eva Mingot-Castellano
  • Giulio Giordano
  • Margherita Scarrone
  • Tomás José González-López
  • Laura Trespidi
  • Daniele Prati
  • Wilma Barcellini

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.

Udgave nummer16
Sider (fra-til)2016-2021
Antal sider6
StatusUdgivet - 2023

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© 2023 The American Society of Hematology

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