title: Labor analgesia in a patient with paroxysmal nocturnal hemoglobinuria with thrombocytopenia.
abstract: OBJECTIVE
  Paroxysmal nocturnal hemoglobinuria (PNH) is a form of acquired hemolytic anemia in which a defect of glycophosphatidylinositol anchor proteins in the cell membrane of bone marrow stem cells leads to activation of the complement system and consequent destruction of defective cells. The characteristics of this disease are an increased frequency of thrombotic events, anemia, and thrombocytopenia.
  
  
  METHODS
  We report a case of a pregnant patient with PNH with thrombocytopenia who delivered vaginally after receiving epidural labor analgesia. Prophylaxis of thromboembolism was performed with heparin 1 hour after the removal of the epidural catheter, and repeated at 12-hour intervals. Sensory changes or motor changes and pain were monitored every 10 minutes for 8 hours after delivery.
  
  
  RESULTS
  During analgesia, the patient reported complete pain relief. Delivery and the immediate postpartum period were without any untoward events.
  
  
  CONCLUSIONS
  Four major factors influenced the anesthetic conduct used for the present patient: (1) the risk of an acute hemolytic crisis, (2) the need to perform prophylaxis for thromboembolism, (3) the need to reduce labor stress, and (4) minimizing the risk of missing an epidural hematoma. We also present a survey of the literature about PNH and discuss the anesthetic conduct in this patient.
authors.affiliation: Department of Surgery, Orthopedics and Traumatology, Faculty of Medicine of Ribeirão Preto, Clinical Hospital of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. rstocche@keynet.com.br
authors.forename: R M
authors.initials: RM
authors.lastname: Stocche
authors.forename: L V
authors.initials: LV
authors.lastname: Garcia
authors.forename: J G
authors.initials: JG
authors.lastname: Klamt
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D005260:Female; D006457:Hemoglobinuria, Paroxysmal / Q000150:complications*; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000503:physiopathology*; D013921:Thrombocytopenia / Q000150:complications*