Clinical analysis of eleven patients with chronic myeloproliferative disorders complicating pregnancy

( views:148, downloads:0 )
BAI Yue-ting()
ZHANG Chao(Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China)
WANG Jian-liu(Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China)
LIANG Mei-ying(Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China)
ZHANG Xiao-hong(Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China)
Journal Title:
Volume 45, Issue 12, 2010
Key Word:
Pregnancy complications, hematologic;Myeloproliferative disorders;Pregnancy outcome;Thrombophilia

Abstract: Objective To investigate the clinical characteristics, the antenatal management, the outcome and prognosis of chronic myeloproliferative disorders (CMPD) complicating pregnancy. Methods Retrospectively analyze the clinical data of eleven patients with CMPD complicating pregnancy hospitalized in Peking University People' s Hospital from 2000 to 2009, including five patients with essential thrombocythemia, one with primary myelofibrosis and five with chronic myeloid leukemia. Results (1)Five pregnancies had periodic antenatal care and laboratory monitorings like full blood count. Reasonable anti-coagulation therapy was given to prevent the complications. One patient with PMF diagnosed before conception had her first pregnancy ended with mild pre-eclampsia and intrauterine death at the gestational age of 32 weeks. During the first trimester of her second pregnancy two years later, the test for anti-β2 glycoprotein antibody was positive. She received low-dose aspirin and low-molecular-weight heparin as anticoagulants. An uneventful course was obtained and she delivered a healthy term infant. (2) Five pregnancies had occasional antenatal examination, including two patients with ET and three patients with CML One patient with ET developed severe pre-eclampsia at the gestational age of 25 weeks. Umbilical artery Doppler showed reversed end-diastolic velocity. The management with anti-convulsants, antihypertensives and anti-coagulants showed no effect. An emergency cesarean section had to be performed because of the aggressive hypertension and placental abruption, with still birth as a result. Two pregnancies never had an antenatal care. Both of them were admitted on labor and the diagnoses of CML were made. (3)Four pregnancies developed oligohydramnios and three developed preelampsia(two severe pre-eclampsia and one mild pre-eclampsia). There was no other hemorrhage and thrombosis event. (4) Eight pregnancies reached full-term with four cesarean sections and four vaginal births. Two preterm cesarean sections were performed because of a progressive oligohydramnios. The ten live neonates weighed 1820 - 3600 g. All were appropriate for gestational age, except one fetal growth retardation (FGR) developed in one patient with severe pre-eclampsia. (5) As for the CMPD, the eleven patients were all in stable conditions. Three patients with CML received hydroxyurea in the third trimester, four with ET and one with CML had plateletpheresis before delivery with favorable effect. All patients were uneventful postpartum, except one with CML who died in 5 months after childbirth. Conclusions The pregnancy outcomes for patients with CMPD are mostly good. However, antenatal care should pay more attention to the complications such as thromboembolic accidents, pre-eclampsia, still birth and fetal growth retardation. Management including reasonable anticoagulation therapy should be considered, which may help improve the prognosis.

  • [1]张之南,单渊东,李蓉生,等.协和血液病学.北京:中国协和医科大学出版社,2004:344,387,601-602,634-644.
  • [2]沈悌.重视骨髓增殖性疾病的诊治与研究.内科急危重症杂志,2009,15:57-58.
  • [3]Harrison C.Pregnancy and its management in the Philadelphia negative myeloproliferative diseases.Br J Haematol,2005,129:293 -306.
  • [4]Griesshammer M,Struve S,Barbui T.Management of Philadelphia negative chronic myeloproliferative disorders in pregnancy.Blood Reviews,2008,22:235 -245.
  • [5]Nelson SM,Greer IA.Thrombophilia and the risk for venous thromboembolism during pregnancy,delivery,and puerperium.Obstet Gynecol Clin North Am,2006,33:413-427.
  • [6]Gotic M,Cvetkovic M,Bozanovic T,et al.Successful treatment of primary myelofibrosis with thrombocytosis during pregnancy with alfa-interferon.Srp Arh Celok Lek,2001,129:304-308.
  • [7]王一,左安兰,刘英慧,等.356例骨髓增殖性疾病的相互转化及其并发症.中华血液学杂志,2002,23:314-317.
  • [8]甘思林,孙慧,马杰,等.伊马替尼治疗慢性粒细胞白血病疗效分析.临床荟萃,2009,24:490-493.
  • [9]王兆钺.原发性血小板增多症研究的进展.中华血液学杂志,2007,28:640-642.
  • [10]Landolfi R,Rocca B,Patrono C.Bleeding and thrombosis in myeloproliferative disorders:mechanisms and treatment.Crit Rev Oncol Hematol,1995,20:203-222.
  • [11]陈梦捷,梁梅英.妊娠合并血小板增多症四例临床分析.中华妇产科杂志,2009,44:445-446.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615