A 37 year old multip presented at 34 weeks with shortness of breath on exertion and yellowed sclera. Investigations showed her to have a haemolytic anaemia (Hb 56 g/l) and abnormal LFTs (ALT 67, bilirubin 58). Liver imaging and virology were normal. The haematologists recommended a bone marrow biopsy which was declined by the patient. Following a blood transfusion she continued to haemolyse so the decision was taken for further blood transfusion and induction of labour at 36 weeks. It emerged that during her last pregnancy, 8 years previously, she had been extensively investigated for deranged LFTs with no cause found. Her Hb at this time was 80g/l but was not investigated. In both pregnancies the abnormalities resolved spontaneously within a few weeks post delivery.

A handful of case reports describe similar cases but all fail to identify the underlying aetiology despite extensive investigations. It has been proposed that there may be an immune-mediated element and that high dose corticosteroids and immunoglobulins may be effective. However there remains a distinct lack of information and guidance available, including a consensus as to whether this should be termed ‘Pregnancy associated haemolytic anaemia’ or indeed ‘Pregnancy induced haemolytic anaemia’.

References

1. Starksen NF. Unexplained hemolytic anemia associated with pregnancy. Am J Obstet Gynecol 1983;146(6):617–22

2. Kumar R. Pregnancy induced hemolytic anemia: an unexplained entity. Ann Hematol 2001;80(10):623–6

3. Bjornsson S. Unexplained haemolytic anaemia in successive pregnancies with negative direct antiglobulin test and response to high dose i.v. IgG. Br J Obstet Gynaecol 1994;101(1):75–7