Autoimmune lymphoproliferative syndrome in pregnancy: A case of favorable mother-fetal outcome in a well-controlled disease

Anaesthetic management of an emergency caesarean section in a complex immunologically compromised patient with pre-eclampsia and multifactorial thrombocytopaenia

A 35-year-old gravida 3, para 0 woman required an emergency caesarean section for pre-eclampsia with severe features including a platelet count of 7 × 10⁹.l^-1. The patient's thrombocytopaenia was an acute on chronic presentation. In addition to pre-eclampsia, the patient had a complex background history which included autoimmune lymphoproliferative syndrome, the manifestations of which include autoimmune cytopaenias and recurrent infections. The patient also had common variable immune deficiency and acquired C1-esterase inhibitor deficiency which may cause life-threatening angioedema, including of the airway. In this report, we describe the potential anaesthetic challenges posed by this pre-eclamptic, immunologically compromised patient with severe thrombocytopaenia and the potential for difficult airway, and how these were addressed in a safe and timely manner. Specifically, we highlight the important considerations when performing a general anaesthetic in this unique combination of circumstances. Although the patient's conditions are rare, this case demonstrates that early multidisciplinary team input can help successfully guide the management of medically complex pregnant patients.

An insight into the role of the death receptor CD95 throughout pregnancy: Guardian, facilitator, or foe

The prototype death receptor CD95 (Fas) and its ligand, CD95L (FasL), have been thoroughly studied due to their role in immune homeostasis and elimination of infected and transformed cells. The fact that CD95 is present in female reproductive cells and modulated during embryogenesis and pregnancy has raised interest in its role in immune tolerance to the fetoplacental unit. CD95 has been shown to be critical for proper embryonic formation and survival. Moreover, altered expression of CD95 or its ligand causes autoimmunity and has also been directly involved in recurrent pregnancy losses and pregnancy disorders. The objective of this review is to summarize studies that evaluate the mechanisms involved in the activation of CD95 to provide an updated global view of its effect on the regulation of the maternal immune system. Modulation of the CD95 system components may be the immune basis of several common pregnancy disorders.