[Use of erythrocytapheresis in a pregnant woman with sickle cell anemia].
A case is reported of a 23 yr old pregnant woman from Zaire in whom homozygous sickle-cell disease was discovered at her first obstetrical visit at 25 week amenorrhea. She had had two previous pregnancies: the first one had been voluntarily interrupted; the second one went to term, but the child, born in a state of apparent death, died on the third day. Despite severe normocytic anaemia (5 mmol.l-1 haemoglobin, 2.9 T.l-1 erythrocytes, 0.25 haematocrit, 93 fl mean globular volume), she was symptomless. The diagnosis was confirmed by haemoglobin electrophoresis: 0 haemoglobin A (HbA) and 0.854 haemoglobin S (HbS). Because foetal growth and maturation appeared satisfactory, no procedure to increase the HbA/HbS ratio was used before the 37th week of amenorrhea. At that time, erythrocytapheresis was carried out using a discontinuous flow cell separator. Eight phenotyped red cell packs without leukocytes (removed by filtration) were transfused; at the end of the procedure, there was 0.67 HbA and 0.25 HbS. At 39 week amenorrhea, haemoglobin electrophoresis gave 0.43 HbA and 0.47 HbS. No further treatment was therefore given. At the 40th week, she gave birth to a healthy girl, Apgar score 10 at 1 min. She was given two further red cell packs at start of labour, because her haemoglobin level had fallen to 6.4 mmol.l-1. In the immediate postpartum, her HbS level was 0.38. The aims, advantages and disadvantages of the different techniques available for the treatment of homozygous sickle-cell anaemia in pregnancy are discussed.
Froehly
S
S
Département d'Anesthésie-Réanimation, Hospices Civils de Strasbourg.
Diemunsch
P
P
Waller
C
C
Renaud
R
R
Gros
H
H
D000328:Adult; D000755:Anemia, Sickle Cell / Q000628:therapy*; D001781:Blood Component Removal / Q000379:methods*; D001797:Blood Protein Electrophoresis; D017707:Erythrocyte Transfusion; D005260:Female; D005434:Flow Cytometry; D006454:Hemoglobins / Q000032:analysis; D006720:Homozygote; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000628:therapy*
D006454:Hemoglobins
Utilisation de l'échange érythrocytaire chez une femme enceinte atteinte de drépanocytose.