Aplastic anemia and immune-mediated thrombocytopenia: concurrent complications encountered in the third trimester of pregnancy

BACKGROUND: Aplastic anemia has been described rarely in pregnancy. The etiology is uncertain, and the treatment of choice, bone marrow transplant, is contraindicated in pregnancy. Thus, the occurrence of this complication during gestation presents a management challenge. Concurrent immune-mediated thrombocytopenia further complicates an already complex situation. CASE: Our patient with aplastic anemia and immune-mediated thrombocytopenia was diagnosed during the third trimester of pregnancy and treated with prednisone/high-dose intravenous (i.v.) immunoglobulin (Ig) and multiple transfusions of packed red blood cells and platelets. Fetal surveillance included twice-weekly non-stress tests coupled with sequential sonographic pregnancy evaluation. A successful term vaginal delivery was achieved with good maternal and perinatal outcomes. CONCLUSION: Selective transfusion of blood products, therapy with prednisone, high-dose i.v. Ig, and intensive fetal surveillance resulted in a successful maternal and perinatal outcome for a pregnancy complicated with aplastic anemia and immune-mediated thrombocytopenia.