title: Pregnancy complicated with agranulocytosis.
abstract: BACKGROUND
  Pregnancy is a complicated physiological process. Physiological leukocytosis often takes place and it is primarily related to the increased circulation of neutrophils, especially during the last trimester of pregnancy. Noncongenital agranulocytosis during pregnancy is rare and reported only occasionally, while in most of the cases, the agranulocytosis has already occurred prior to pregnancy or induced by identified factors such as antibiotics, antithyroid agents, or cytotoxic agents. Gestation-induced agranulocytosis has not been reported, so we present a case of gestation-induced agranulocytosis in this article.
  
  
  METHODS
  In this case, we present a Chinese woman (aged 25) in her 38th week of the first gestation who had the complication of agranulocytosis. No abnormality was detected in regular examinations before pregnancy and in the first trimester. Since the last trimester of pregnancy, the patient began to suffer from agranulocytosis and intermittent fever, the maximum being temperature 38.8°C. At admission, the neutrophil granulocytes were 0.17 × 10 L and the bone marrow biopsy showed that agranulocytosis was detected, but the levels of red blood cell and megalokaryocyte were normal. In addition, antinuclear antibodies were detected at a dilution of 1:40, but anti-dsDNA, antiphospholipid antibody, and neutrophil granulocyte antibody were negative.
  
  
  METHODS
  The patient was empirically treated as having pneumonia.
  
  
  METHODS
  We tried to use granulocyte colony-stimulating factor, γ-globulin, glucocorticoids, antibiotics, and antifungi agents to treat the patient, but her symptoms were not alleviated until the patient had a cesarean section.
  
  
  RESULTS
  After 24 hours of cesarean section, the temperature and neutrophil granulocyte returned to normal. After a year of follow-up, we found that the patient and the baby were healthy.
  
  
  CONCLUSIONS
  Agranulocytosis during pregnancy seems to be associated with immunosuppression induced by immunoregulations and termination of pregnancy may be effective for refractory pregnancy complicated with agranulocytosis, but further studies are needed to confirm this.
authors.affiliation: Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, PR China.
authors.forename: Hai
authors.initials: H
authors.lastname: Wang
authors.forename: Jiang-Li
authors.initials: JL
authors.lastname: Sun
authors.forename: Zheng-Liang
authors.initials: ZL
authors.lastname: Zhang
authors.forename: Hong-Hong
authors.initials: HH
authors.lastname: Pei
mesh_terms: D000328:Adult; D000380:Agranulocytosis / Q000150:complications* / Q000503:physiopathology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002585:Cesarean Section; D005260:Female; D005334:Fever / Q000150:complications; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis* / Q000503:physiopathology
chemical_list: D000900:Anti-Bacterial Agents