title: Two consecutive pregnancies in a patient with paroxysmal nocturnal haemoglobinuria treated with anticoagulant therapy at different doses.
abstract: Paroxysmal nocturnal haemoglobinuria (PNH) is a rare acquired disorder of haematopoietic stem cells characterized by intravascular haemolysis, cytopenias and thrombophilia. Thrombophilia is the leading cause of mortality in patients with PNH. As the risk of thrombogenesis further increases during pregnancy and the postpartum period, an anticoagulant therapy is generally recommended for pregnant women with PNH. However, there are no standardized criteria for determining the appropriate dose of anticoagulant therapy. We describe the case of a PNH patient with who was managed with anticoagulant therapy at different doses during two consecutive pregnancies. A prophylactic dose of heparin was administered during her first pregnancy and a therapeutic dose, during her second pregnancy. Both pregnancies resulted in uncomplicated vaginal deliveries without thrombosis. Interestingly, not only D-dimer (as a thrombotic marker) but also lactate dehydrogenase (as a haemolytic marker) levels were lower during her second pregnancy when a therapeutic dose of heparin was used.
authors.affiliation: aDepartment of Obstetrics and Gynecology bDepartment of Hematology and Oncology, Osaka University Graduate School of Medicine cDivision of Hematology and Rheumatology, Department of Internal Medicine, Kinki University Faculty of Medicine, Osaka, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Sasano
authors.forename: Takuji
authors.initials: T
authors.lastname: Tomimatsu
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Nishimura
authors.forename: Itaru
authors.initials: I
authors.lastname: Matsumura
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Kanakura
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006457:Hemoglobinuria, Paroxysmal / Q000188:drug therapy* / Q000401:mortality; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D011247:Pregnancy; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006493:Heparin