SUCCESSFUL TREATMENT OF PREGNANCY-ASSOCIATED SEVERE APLASTIC-ANEMIA BY IMMUNOSUPPRESSION - A CASE-REPORT AND REVIEW OF THE LITERATURE

Severe aplastic anemia (SAA) developing in pregnancy is a serious cond ition in which therapeutic options like antithymocyte globulin (ATG), immunosuppression, and bone mat-row transplantation (BMT) must be cons idered if the fetus is to survive. We consider a case of SAA developin g in a 27-year-old woman in the 20th week of her third pregnancy is de scribed. Until delivery at 36 weeks the patient received 48 units of i rradiated leukocyte-free erythrocytes and 60 units of single-donor pla telets. At week 36 cesarean hysterectomy was performed, and a healthy 2540-g boy was delivered. BMT could not be performed as no matching do nor was available. After delivery ATG therapy was started. The patient remained transfusion-dependent. Leukcocyte count improved after splen ectomy, and complete remission of SAA with self-sustaining hematopoies is was observed 19 months after delivery. The patient is in complete h ematological remission 4 years after ATG treatment. Our report is the first showing long term survival after SAA developing in pregnancy in a patient that was not treated with BMT.