he major risks with hypoplastic anemia are hemorrhage and infection. Rates of preterm labor, preeclampsia, fetal-growth restriction, and stillbirth are increased (Bo, 2016). Management depends on gestational age, and supportive care includes continuous infection surveillance and prompt antimicrobial therapy. Granulocyte transfusions are given only during infections. Red cells are transfused to improve symptomatic anemia and routinely to maintain the hematocrit at or above 20 volumes percent. Platelet transfusions may be needed to control hemorrhage. Maternal mortality rates reported since 1960 have averaged nearly 50 percent, however, better outcomes have been reported more recently (Choudhry, 2002; Kwon, 2006).
Several reports describe successful pregnancies in women who have undergone bone marrow transplantation (BorgnaPignatti, 1996; Eliyahu, 1994). In their review, Sanders and coworkers (1996) reported 72 pregnancies in 41 women who had undergone transplantation. In the 52 pregnancies resulting in a liveborn neonate, almost half were complicated by preterm delivery or hypertension. Our experiences with a few of these women indicate that they have normal pregnancy-augmented erythropoiesis and total blood volume expansion.
Excessive erythrocytosis during pregnancy is usually related to chronic hypoxia from maternal congenital cardiac disease or a chronic pulmonary disorder. Unusually heavy cigarette smoking can cause polycythemia. We have encountered otherwise healthy pregnant women who were heavy smokers, had chronic bronchitis, and had hematocrits ranging from 55 to 60 volumes percent! If polycythemia is severe, the probability of a successful pregnancy outcome is low.
This is a primary clonal myeloproliferative hemopoietic stemcell disorder characterized by excessive proliferation of erythroid, myeloid, and megakaryocytic precursors (Spivak, 2015; Vannucchi, 2015). Virtually all patients have either aJA2V617F or aJA2 exon 12 gene mutation (Harrison, 2009). Symptoms are related to increased blood viscosity, and thrombotic complications are common. Treatment of nonpregnant patients is with hydroxyurea or ruxolitinib (Vannucchi, 2015).
Fetal loss rates are high in women with polycythemia vera, and pregnancy outcome may be improved with aspirin therapy (Griesshammer, 2006; Robinson, 2005; Teferi, 2000). Women with a history of venous thrombosis are given prophylaxis with low-molecular-weight heparin. If cytoreduction is required during pregnancy, interferon alpha may be considered (Kreher, 2014).
Hemoglobin A is the most common hemoglobin tetramer and consists of two .-and two 3-chains. In contrast, sickle hemoglobin (hemoglobin S) originates from a single 3-chain substitution of glutamic acid by valine, which stems from an A-for-T substitution at codon 6 of the 3-globin gene. Hemoglobinopathies that can result in clinical features of the sickle-cell syndrome include sickle-cell anemia (Hb SS); sickle-cell hemoglobin C disease (Hb SC); sickle-cell 3-thalassemia disease (either Hb SI or Hb S/B+); and sickle-cell E disease (Hb SE) (Benz, 2015). All are also associated with increased pregnancy morbidity.