Vol 7, No 4 (2016)
Review paper
Published online: 2017-04-07

open access

Page views 1831
Article views/downloads 9685
Get Citation

Connect on Social Media

Connect on Social Media

Hematologic complications during pregnancy

Izabella Kopeć
Hematologia 2016;7(4):295-302.


Anemia and thrombocytopenia in pregnancy are common health problems. It is estimated world­wide that the prevalence of anemia in pregnancy is around 38%, whilst thrombocytopenia occurs in 7–12% of all pregnancies. Malignancy is the second most frequent cause of mortality during childbearing years and is a complication in up to 1 out of every 1000 pregnancies. The most com­mon hematologic malignancies associated with pregnancy are lymphomas (1: 1000–6000) and leukemias (1: 75 000–100 000). This paper is a detailed review in the diagnosis and management of benign or malignant hematologic disorders whenever occurring during pregnancy.

Article available in PDF format

View PDF (Polish) Download PDF file


  1. Paidas MJ, Hassain N. Hematologic changes in pregnancy w hemostasis thrombosis obstetrics gynecology. In: Paidas MJ, Hassain N, Shamsi TS. ed. Hemostasis and thrombosisin obstetrics & gynecology. Wiley-Blackwell, Oxford 2010: 1–11.
  2. Duffy TP. Hematologic aspects of pregnancy. In: Hoffman R, Benz EJ, Furie B, Cohen HJ, Silberstein LE, McGlave P. ed. Hematology. Basic principles and practice. Churchil Livingstone, New York, Edinburgh, London, Philadelphia, San Francisco 2000: 2375.
  3. Pavord S, Myers B, Robinson S, et al. British Committee for Standards in Haematology. UK guidelines on the management of iron deficiency in pregnancy. Br J Haematol. 2012; 156(5): 588–600.
  4. Yakoob MY, Bhutta ZA. Effect of routine iron supplementation with or without folic acid on anemia during pregnancy. BMC Public Health. 2011; 11 Suppl 3: S21.
  5. Townsley DM. Hematologic complications of pregnancy. Semin Hematol. 2013; 50(3): 222–231.
  6. Baker WF, Lee R. Iron deficiency, folate, and vitamin B12 deficiency in pregnancy, obstetrics, and gynecology. In: Bick RL, Frenkel EP, Baker WF, Sarode R. ed. Hematological complications in obstetrics, pregnancy and gynecology. Cambridge University Press, Cambridge 2006: 269–309.
  7. Gaillard R, Eilers PHC, Yassine S, et al. Risk factors and consequences of maternal anaemia and elevated haemoglobin levels during pregnancy: a population-based prospective cohort study. Paediatr Perinat Epidemiol. 2014; 28(3): 213–226.
  8. Devalia V, Hamilton MS, Molloy AM, et al. British Committee for Standards in Haematology. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol. 2014; 166(4): 496–513.
  9. Bolton-Maggs PHB, Langer JC, Iolascon A, et al. General Haematology Task Force of the British Committee for Standards in Haematology. Guidelines for the diagnosis and management of hereditary spherocytosis--2011 update. Br J Haematol. 2012; 156(1): 37–49.
  10. Nordvall M, Dziegiel M, Hegaard HK, et al. Red blood cell antibodies in pregnancy and their clinical consequences: synergistic effects of multiple specificities. Transfusion. 2009; 49(10): 2070–2075.
  11. Foudoulaki-Paparizos L, Valsami S, Bournas N, et al. Alloimmunisation during pregnancy in Greece: need for nationwide HDFN prevention programme. Transfus Med. 2013; 23(4): 254–259.
  12. Hoppe B, Stibbe W, Bielefeld A, et al. Increased RBC autoantibody production in pregnancy. Transfusion. 2001; 41(12): 1559–1561.
  13. Meulenbroek EM, Wouters D, Zeerleder SS. Lyse or not to lyse: clinical significance of red blood cell autoantibodies. Blood Rev. 2015; 29: 369–376.
  14. Lechner K, Jäger U. How I treat autoimmune hemolytic anemias in adults. Blood. 2010; 116(11): 1831–1838.
  15. Scully M, Hunt BJ, Benjamin S, et al. British Committee for Standards in Haematology. Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. Br J Haematol. 2012; 158(3): 323–335.
  16. Gernsheimer TB. Thrombocytopenia in pregnancy: is this immune thrombocytopenia or...? Hematology Am Soc Hematol Educ Program. 2012; 2012: 198–202.
  17. McCrae KR. Thrombocytopenia in pregnancy. Hematology Am Soc Hematol Educ Program. 2010: 397–402.
  18. Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010; 115(2): 168–186.
  19. Gernsheimer T, James AH, Stasi R. How I treat thrombocytopenia in pregnancy. Blood. 2013; 121(1): 38–47.
  20. Sun D, Shehata N, Ye XY, et al. Corticosteroids compared with intravenous immunoglobulin for the treatment of immune thrombocytopenia in pregnancy. Blood. 2016; 128(10): 1329–1335.
  21. Stavrou E, McCrae KR. Immune thrombocytopenia in pregnancy. Hematol Oncol Clin North Am. 2009; 23(6): 1299–1316.
  22. Noris P, Schlegel N, Klersy C, et al. European Hematology Association – Scientific Working Group on Thrombocytopenias and Platelet Function Disorders. Analysis of 339 pregnancies in 181 women with 13 different forms of inherited thrombocytopenia. Haematologica. 2014; 99(8): 1387–1394.
  23. Fausett B, Silver RM. Congenital disorders of platelet function. Clin Obstet Gynecol. 1999; 42(2): 390–405.
  24. Koyama S, Tomimatsu T, Kanagawa T, et al. Reliable predictors of neonatal immune thrombocytopenia in pregnant women with idiopathic thrombocytopenic purpura. Am J Hematol. 2012; 87(1): 15–21.
  25. Chakravorty S, Roberts I. How I manage neonatal thrombocytopenia. Br J Haematol. 2012; 156(2): 155–162.
  26. Van Calsteren K, Amant F. Cancer during pregnancy. Acta Obstet Gynecol Scand. 2014; 93(5): 443–446.
  27. Basta P, Bak A, Roszkowski K. Cancer treatment in pregnant women. Contemp Oncol (Pozn). 2015; 19(5): 354–360.
  28. Peccatori FA, Azim HA, Orecchia R, et al. ESMO Guidelines Working Group. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013; 24 Suppl 6: 160–170.
  29. Vandenbriele C, Dierickx D, Amant F, et al. The treatment of hematologic malignancies in pregnancy. Facts Views Vis Obgyn. 2010; 2(2): 74–87.
  30. Lavi N, Horowitz NA, Brenner B. An update on the management of hematologic malignancies in pregnancy. Womens Health (Lond). 2014; 10(3): 255–266.
  31. Amant F, Vandenbroucke T, Verheecke M, et al. International Network on Cancer, Infertility, and Pregnancy (INCIP). Pediatric Outcome after Maternal Cancer Diagnosed during Pregnancy. N Engl J Med. 2015; 373(19): 1824–1834.
  32. Avivi I, Farbstein D, Brenner B, et al. Non-Hodgkin lymphomas in pregnancy: tackling therapeutic quandaries. Blood Rev. 2014; 28(5): 213–220.
  33. Mahmoud HK, Samra MA, Fathy GM. Hematologic malignancies during pregnancy: A review. J Adv Res. 2016; 7(4): 589–596.
  34. Ali S, Jones GL, Culligan DJ, et al. British Committee for Standards in Haematology. Guidelines for the diagnosis and management of acute myeloid leukaemia in pregnancy. Br J Haematol. 2015; 170(4): 487–495.
  35. Thomas X, Thomas X, Chelghoum Y, et al. Acute leukemia during pregnancy: a report on 37 patients and a review of the literature. Cancer. 2005; 104(1): 110–117.
  36. Pye SM, Cortes J, Ault P, et al. The effects of imatinib on pregnancy outcome. Blood. 2008; 111(12): 5505–5508.
  37. Pistilli B, Bellettini G, Giovannetti E, et al. Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: how should we counsel cancer patients about breastfeeding? Cancer Treat Rev. 2013; 39(3): 207–211.
  38. Harrison CN, Bareford D, Butt N, et al. British Committee for Standards in Haematology. Guideline for investigation and management of adults and children presenting with a thrombocytosis. Br J Haematol. 2010; 149(3): 352–375.
  39. Palandri F, Polverelli N, Ottaviani E, et al. Long-term follow-up of essential thrombocythemia in young adults: treatment strategies, major thrombotic complications and pregnancy outcomes. A study of 76 patients. Haematologica. 2010; 95(6): 1038–1040.
  40. Robinson S, Bewley S, Hunt BJ, et al. The management and outcome of 18 pregnancies in women with polycythemia vera. Haematologica. 2005; 90(11): 1477–1483.
  41. McMullin MF, Bareford D, Campbell P, et al. General Haematology Task Force of the British Committee for Standards in Haematology. Guidelines for the diagnosis, investigation and management of polycythaemia/erythrocytosis. Br J Haematol. 2005; 130(2): 174–195.
  42. Bachanova V, Connors J. Hodgkin Lymphoma in Pregnancy. Current Hematologic Malignancy Reports. 2013; 8(3): 211–217.
  43. Avivi I, Farbstein D, Brenner B, et al. Non-Hodgkin lymphomas in pregnancy: tackling therapeutic quandaries. Blood Rev. 2014; 28(5): 213–220.
  44. El-Messidi A, Patenaude V, Abenhaim HA. Incidence and outcomes of women with non-Hodgkin's lymphoma in pregnancy: a population-based study on 7.9 million births. J Obstet Gynaecol Res. 2015; 41(4): 582–589.
  45. Donnez J, Dolmans MM. Preservation of fertility in females with haematological malignancy. Br J Haematol. 2011; 154(2): 175–184.
  46. Diller L. Clinical practice. Adult primary care after childhood acute lymphoblastic leukemia. N Engl J Med. 2011; 365(15): 1417–1424.
  47. Barton SE, Najita JS, Ginsburg ES, et al. Infertility, infertility treatment, and achievement of pregnancy in female survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort. Lancet Oncol. 2013; 14(9): 873–881.

Hematology in Clinical Practice