title: Successful pregnancy outcome in paroxysmal nocturnal hemoglobinuria (PNH) following escalated eculizumab dosing to control breakthrough hemolysis.
abstract: Pregnancy in women with paroxysmal nocturnal hemoglobinuria (PNH) is associated with increased maternal and fetal morbidity and mortality. There is limited published experience regarding therapy of PNH during pregnancy. We describe a case of a 30 year old female with hypoplastic myelodysplastic syndrome and PNH. After two years of treatment with eculizumab, she became pregnant. She developed breakthrough hemolysis at 20 weeks gestation. Pharmacokinetic and pharmacodynamic studies demonstrated a subtherapeutic eculizumab level with absence of complement blockade. Escalation of her eculizumab dose successfully controlled hemolysis and restored therapeutic eculizumab level and activity. She delivered a healthy baby at 36 weeks.
authors.affiliation: Division of Hematology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Lake Success, NY, USA.
authors.forename: Ruby
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Division of Hematology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Lake Success, NY, USA.
authors.forename: Alla
authors.initials: A
authors.lastname: Keyzner
authors.affiliation: Division of Hematology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Lake Success, NY, USA.
authors.forename: Johnson
authors.initials: J
authors.lastname: Liu
authors.affiliation: Division of Hematology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Lake Success, NY, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bradley
authors.affiliation: Division of Hematology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Lake Success, NY, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Allen
keywords: Breakthrough PNH hemolysis complicating pregnancy; Escalated eculizumab dosing