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Mohamed S, Ibrahim F, Alasafar MN, Alshurafa A, Akiki S, Soliman D, Kohla S, Amer A, Qasim H, Cherif H. Recurrent sideroblastic anemia during pregnancy. Clin Case Rep 2023; 11:e6814. [PMID: 36644616 PMCID: PMC9834147 DOI: 10.1002/ccr3.6814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 11/01/2022] [Accepted: 12/14/2022] [Indexed: 01/15/2023] Open
Abstract
Sideroblastic anemia is a heterogeneous group of disorders typified by the presence of ring sideroblasts in the bone marrow and has congenital and acquired types. Sideroblastic anemia is a rare event in pregnancy. We report a case of a 32-year-old female patient, gravida 4 para 3, 27th weeks pregnant, who presented to the emergency department complaining of palpitation and generalized weakness for 2 weeks. She was found to have severe normochromic normocytic anemia, with hemoglobin of 4.2 g/dl, and low reticulocytes count of 13 × 103/μl. She gave a history of recurrent anemia, which had only occurred during pregnancy. Her bone marrow aspirate showed many ring sideroblasts concluding the diagnosis of sideroblastic anemia (SA). Further investigation revealed a significantly low pyridoxine level (vitamin B6) of (8 nmol/L). The Hb level improved with vitamin B6 replacement, without any transfusion support.
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Affiliation(s)
- Shehab Mohamed
- Department of HematologyNational Center for Cancer Care and Research, Hamad Medical CorporationDohaQatar
| | - Firyal Ibrahim
- Department of Laboratory Medicine and PathologyNational Center for Cancer Care and Research, Hamad Medical CorporationDohaQatar
| | | | - Awni Alshurafa
- Department of HematologyNational Center for Cancer Care and Research, Hamad Medical CorporationDohaQatar
| | - Susanna Akiki
- Department of Laboratory Medicine and PathologyHamad Medical CorporationDohaQatar,Weill Cornell Medicine‐QatarDohaQatar
| | - Dina Soliman
- Department of Laboratory Medicine and PathologyNational Center for Cancer Care and Research, Hamad Medical CorporationDohaQatar
| | - Samah Kohla
- Department of Laboratory Medicine and PathologyNational Center for Cancer Care and Research, Hamad Medical CorporationDohaQatar
| | - Aliaa Amer
- Department of Laboratory Medicine and PathologyNational Center for Cancer Care and Research, Hamad Medical CorporationDohaQatar
| | - Hana Qasim
- Department of HematologyNational Center for Cancer Care and Research, Hamad Medical CorporationDohaQatar
| | - Honar Cherif
- Department of HematologyNational Center for Cancer Care and Research, Hamad Medical CorporationDohaQatar
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Lobbes H. [Pure red cell aplasia: Diagnosis, classification and treatment]. Rev Med Interne 2023; 44:19-26. [PMID: 36336519 DOI: 10.1016/j.revmed.2022.10.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
Pure red cell aplasia (PRCA) is a rare anemia characterised by profound reticulocytopenia caused by a marked reduction in bone marrow erythroblasts, without abnormalities in other blood lineages. Blackfan-Diamond anemia is an inherited ribosomopathy responsible for a hereditary form of PRCA. Acquired PRCA are separated in primary and secondary forms, including Parvovirus B19 infection, thymoma, lymphoproliferative disorders, autoimmune diseases (lupus) and drug-induced PRCA. The pathophysiology of PRCA is not fully understood and involves both humoral and T lymphocyte autoreactive cells. In Parvovirus B19-related PRCA, treatment is based on polyvalent immunoglobulins. Thymectomy for thymoma is mandatory but results in prolonged remission in a limited number of cases. The therapeutic strategy is based on expert opinion: corticosteroids in monotherapy provide few sustained responses. The choice of an additional immunosuppressant drug is guided by the presence of an underlying disease. In most cases, cyclosporine A is the first choice providing the best response rate but requires a concentration monitoring (150 to 250 ng/mL). The second choice is cyclophosphamide in large granular lymphocyte leukaemia. Sirolimus (mTOR inhibitor) seems to be a promising option especially in refractory cases. Transfusion independence is the main objective. If the patient receives numerous red blood cell transfusions (> 20 packs), iron overload assessment is crucial to initiate an iron chelation. A retrospective and prospective national cohort (EPIC-F) has been set up and is now available to include each case of PRCA to improve the knowledge of this disease and to optimize the therapeutic strategy.
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Affiliation(s)
- Hervé Lobbes
- Service de médecine interne, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000 Clermont-Ferrand, France.
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Shibata M, Kaneko K, Umehara N, Matsui H, Kawai T, Nakadate H, Murashimia A, Sago H. A pregnant woman with thymoma-associated pure red cell aplasia. BMC Pregnancy Childbirth 2022; 22:795. [PMID: 36303124 PMCID: PMC9608914 DOI: 10.1186/s12884-022-05145-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background Pure red cell aplasia (PRCA) is a hematological disorder characterized by anemia with severe reticulocytopenia caused by a marked reduction in erythroid precursors in the bone marrow. PRCA is known to be associated with pregnancy, but thymoma-associated PRCA during pregnancy is very rare, and its successful management has not been reported. Case presentation A 37-year-old primiparous woman with severe anemia was referred to our center at 27 weeks’ gestation. She was diagnosed with PRCA based on bone aspiration findings at 33 weeks’ gestation. Magnetic resonance imaging (MRI) revealed an anterior mediastinal mass 4 cm in size suspected of being thymoma. She was therefore diagnosed with thymoma-associated PRCA during pregnancy. Surgery for thymoma was planned after delivery, since the imaging findings were suggestive of early-stage thymoma (Masaoka stage I or II). With transfusion of a total 3,360 ml of red blood cells (RBCs) during pregnancy, the patient gave birth to a baby girl weighing 2,548 g at 40 weeks’ gestation. The baby showed transient congenital cutaneous candidiasis. The placental pathology revealed subamniotic inflammation with a fungal structure. Treatment with topical anti-fungal cream immediately ameliorated the baby’s skin lesion. Maternal anemia did not improve after delivery; however, the thymoma did not increase in size. At five months after delivery, the mother underwent thymectomy with oral cyclosporine A. A pathological examination revealed Masaoka stage II-a thymoma. She completely had recovered from anemia at six months after surgery. Cyclosporine A treatment was discontinued three years after surgery. Remission has been sustained for four years since surgery. Conclusions A very rare case of thymoma-associated PRCA during pregnancy was diagnosed without any subjective symptoms and was expectantly managed, resulting in a good prognosis. Although bone marrow aspiration during pregnancy is an invasive test, it is important to confirm the diagnosis. Conservative management with blood transfusion was possible for early-stage thymoma-associated PRCA during pregnancy. Active surveys, including MRI, for PRCA during pregnancy led to the detection of thymoma at an early stage and the achievement of a preferable pregnancy outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05145-5.
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Affiliation(s)
- Megumi Shibata
- grid.63906.3a0000 0004 0377 2305Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, Japan
| | - Kayoko Kaneko
- grid.63906.3a0000 0004 0377 2305Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, Japan
| | - Nagayoshi Umehara
- grid.63906.3a0000 0004 0377 2305Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, Japan
| | - Hitoshi Matsui
- grid.63906.3a0000 0004 0377 2305Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, Japan
| | - Toshinao Kawai
- grid.63906.3a0000 0004 0377 2305Division of Immunology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, Japan
| | - Hisaya Nakadate
- grid.63906.3a0000 0004 0377 2305Division of Hematology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, Japan
| | - Atsuko Murashimia
- grid.63906.3a0000 0004 0377 2305Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, Japan
| | - Haruhiko Sago
- grid.63906.3a0000 0004 0377 2305Division of Obstetrics, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, Japan
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Herrera-Quintana JF, Rojas-Figueroa AC, Aragón-Mendoza RL, Gallo-Roa R, Castillo-Zamora MF. Pure red-cell aplasia secondary to pregnancy: Case report and review of the literature. ACTA ACUST UNITED AC 2020; 71:365-373. [PMID: 33515443 DOI: 10.18597/rcog.3543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 11/18/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To report a case of pure red-cell aplasia secondary to pregnancy and to conduct a review of the literature regarding diagnosis and treatment, as well as maternal and perinatal prognosis. METHODS This is the case of a 24-year-old patient at 34 weeks of gestation, referred to a regional public referral hospital due to anemia. Bone marrow biopsy was performed, leading to the diagnosis of pregnancy-related pure red-cell aplasia. The patient received serial red blood cell transfusions. Delivery by Cesarean section at term resulted in a healthy newborn. Hemoglobin values remained stable during the postoperative period. A literature search was conducted in Medline via PubMed, LILACS, SciELO and ScienceDirect using the terms "pregnancy" and "pure red-cell aplasia". Case reports, case series and literature reviews in English and Spanish published between January 1999 and January 2020 that report pregnant women with pure red-cell aplasia were included. Information on diagnosis, treatment and maternal and perinatal prognosis was collected. Three of the authors selected the studies by title and abstract; A descriptive synthesis is provided. RESULTS Overall, 828 titles were identified; of these,818 were discarded after reviewing the inclusions criteria. Ten articles were included: six case reports, three case reports with literature review, and one case report in the poster modality, for a total number of 10 reported cases. Diagnosis was based on low hemoglobin levels and compromised erythroid cell line in bone marrow biopsy. Treatment consists of red blood cell transfusions, with good maternal and fetal prognosis. CONCLUSIONS Diagnosis of pure red-cell aplasia during pregnancy requires bone marrow biopsy. With transfusion support, maternal perinatal prognosis is good. Further studies are required to assess the safety and efficacy of steroid use in this pregnancy-related condition.
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Affiliation(s)
| | | | | | - Roberto Gallo-Roa
- Médico, ginecobstetra, Hospital Universitario de La Samaritana, Bogotá (Colombia)
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Rao A, Rao R. Recurrent Pregnancy-Related Pure Red Cell Aplasia Responsive to Combined Corticosteroid and Azathioprine Therapy: A Management Dilemma. Turk J Haematol 2020; 37:213-215. [PMID: 32394690 PMCID: PMC7463210 DOI: 10.4274/tjh.galenos.2020.2020.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Ashwin Rao
- Salem Polyclinic, Department of Obstetrics and Gynecology, Tamil Nadu, India
| | - Rashmi Rao
- Salem Polyclinic, Department of Obstetrics and Gynecology, Tamil Nadu, India
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