Vol 7, No 4 (2016)
Review paper
Published online: 2017-04-07
Hematologic complications during pregnancy
Hematologia 2016;7(4):295-302.
Abstract
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.
Keywords: pregnancyanemiatrombocytopenialeukemialymphoma
References
- 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.
- 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.
- 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.
- 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.
- Townsley DM. Hematologic complications of pregnancy. Semin Hematol. 2013; 50(3): 222–231.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Hoppe B, Stibbe W, Bielefeld A, et al. Increased RBC autoantibody production in pregnancy. Transfusion. 2001; 41(12): 1559–1561.
- Meulenbroek EM, Wouters D, Zeerleder SS. Lyse or not to lyse: clinical significance of red blood cell autoantibodies. Blood Rev. 2015; 29: 369–376.
- Lechner K, Jäger U. How I treat autoimmune hemolytic anemias in adults. Blood. 2010; 116(11): 1831–1838.
- 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.
- Gernsheimer TB. Thrombocytopenia in pregnancy: is this immune thrombocytopenia or...? Hematology Am Soc Hematol Educ Program. 2012; 2012: 198–202.
- McCrae KR. Thrombocytopenia in pregnancy. Hematology Am Soc Hematol Educ Program. 2010: 397–402.
- 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.
- Gernsheimer T, James AH, Stasi R. How I treat thrombocytopenia in pregnancy. Blood. 2013; 121(1): 38–47.
- 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.
- Stavrou E, McCrae KR. Immune thrombocytopenia in pregnancy. Hematol Oncol Clin North Am. 2009; 23(6): 1299–1316.
- 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.
- Fausett B, Silver RM. Congenital disorders of platelet function. Clin Obstet Gynecol. 1999; 42(2): 390–405.
- 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.
- Chakravorty S, Roberts I. How I manage neonatal thrombocytopenia. Br J Haematol. 2012; 156(2): 155–162.
- Van Calsteren K, Amant F. Cancer during pregnancy. Acta Obstet Gynecol Scand. 2014; 93(5): 443–446.
- Basta P, Bak A, Roszkowski K. Cancer treatment in pregnant women. Contemp Oncol (Pozn). 2015; 19(5): 354–360.
- 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.
- Vandenbriele C, Dierickx D, Amant F, et al. The treatment of hematologic malignancies in pregnancy. Facts Views Vis Obgyn. 2010; 2(2): 74–87.
- Lavi N, Horowitz NA, Brenner B. An update on the management of hematologic malignancies in pregnancy. Womens Health (Lond). 2014; 10(3): 255–266.
- 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.
- Avivi I, Farbstein D, Brenner B, et al. Non-Hodgkin lymphomas in pregnancy: tackling therapeutic quandaries. Blood Rev. 2014; 28(5): 213–220.
- Mahmoud HK, Samra MA, Fathy GM. Hematologic malignancies during pregnancy: A review. J Adv Res. 2016; 7(4): 589–596.
- 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.
- 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.
- Pye SM, Cortes J, Ault P, et al. The effects of imatinib on pregnancy outcome. Blood. 2008; 111(12): 5505–5508.
- 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.
- 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.
- 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.
- 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.
- 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.
- Bachanova V, Connors J. Hodgkin Lymphoma in Pregnancy. Current Hematologic Malignancy Reports. 2013; 8(3): 211–217.
- Avivi I, Farbstein D, Brenner B, et al. Non-Hodgkin lymphomas in pregnancy: tackling therapeutic quandaries. Blood Rev. 2014; 28(5): 213–220.
- 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.
- Donnez J, Dolmans MM. Preservation of fertility in females with haematological malignancy. Br J Haematol. 2011; 154(2): 175–184.
- Diller L. Clinical practice. Adult primary care after childhood acute lymphoblastic leukemia. N Engl J Med. 2011; 365(15): 1417–1424.
- 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.
