2022, Number 01
<< Back Next >>
Ginecol Obstet Mex 2022; 90 (01)
Pregnancy with beta-thalassemia minor and development of low-frequency irregular alloantibody. Report of a case
Soni-Trinidad C, Vázquez-García RE, Soni-Gallardo J, Rodríguez-Infante LI, Velasco-Cárdenas DF, Sosa-González CK
Language: Spanish
References: 23
Page: 90-95
PDF size: 169.58 Kb.
ABSTRACT
Background: About 7% of pregnant women have some type of hemoglobinopathy including beta-thalassemia which corresponds to an alteration of the beta chains of the hemoglobin molecule. The treatment of these patients is with multiple blood transfusions, with the risk of alloimmunization.
Clinical case: 29-year-old patient with a diagnosis of beta-thalassemia minor seen in the Gynecology and Obstetrics Department in her first pregnancy, with recurrent severe anemic syndrome. She was transfused 7 globular packets, cause of irregular low-frequency anti-E alloantibody. The pregnancy was terminated at 39 weeks by cesarean section, with a live male newborn of 3550 g, Apgar 9-9, without complications. At 35 years of age, she had the second pregnancy which during its evolution required the transfusion of phenotyped blood with nine erythrocyte concentrates. The pregnancy was terminated by cesarean section at 38 weeks, with birth of a girl of 3220 g, Apgar 8-9, without risks or complications for the mother and her daughter.
Conclusion: The prevention of alloimmunization in the treatment of pregnant women with beta-thalassemia minor consists of establishing the phenotype of the red blood cells to determine systems other than the traditional AB0 or Rh, to avoid sensitization reactions and production of alloantibodies which, if they cross the placental barrier, could cause an immune response in the fetus due to maternal-fetal incompatibility.
REFERENCES
Vargas C. β-Talasemia. Rev Med Cos Cen 2011; 68 (598): 355-7. https://www.medigraphic.com/pdfs/revmedcoscen/rmc-2011/rmc113q.pdf
Aixalá M. Anemia microcítica-hipocrómica: anemia ferropénica versus b talasemia menor. Acta Bioquím Clín Latinoam [en línea]. 2017; 51 (3): 291-305.https://www.redalyc.org/articulo.oa?id=53553013004
Alzate J, et al. Herramientas diagnósticas para hemoglobinopatías. 6º Ciclo Internacional de Conferencias de la Calidad [en línea]. 2012. https://www.ifcc.org/media/216143/Hemoglobinopatias.pdf
Ibarra B. III-Talasemia. Gac Méd Méx 2003; 139 (2): S8-11.
Brancaleoni V, et al. Laboratory diagnosis of thalassemia. Int Jnl Lab Hem. 2016; 38 (1): 32-40. https://doi.org/10.1111/ijlh.12527
Clark B, Thein C. Molecular diagnosis of haemoglobin disorders. Clin Lab Haem. 2004; 26 (3): 159-76. https://doi.org/10.1111/j.1365-2257.2004.00607.x
Ruiz A, et al. Anemia hemolítica hereditaria y sobrecarga de hierro. Vitae [en línea]. 2013; (53): 1-8. https://vitae.ucv.ve/pdfs/VITAE_4721.pdf
Ruiz-Argüelles G. Hemoglobinas anormales y talasemias en la República Mexicana. Rev Hematol Mex 1998; 50 (2): 163-70. https://pesquisa.bvsalud.org/portal/resource/pt/lil-232796
Modell B, Matthew D. Epidemiología mundial de las hemoglobinopatías e indicadores de los servicios correspondientes. Boletín de la Organización Mundial de la Salud 2008; 86: 419-26. https://www.who.int/bulletin/volumes/86/6/06-036673.pdf?ua=1
Chiappe G. Talasemias: Aspectos clínicos. Acta Bioquím Clín Latinoam 2017; 51(3): 281-9. https://www.redalyc.org/pdf/535/53553013003.pdf
Lugones-Botell M, Hernández-Álvarez F. Betatalasemia y embarazo. Rev Cubana Obstet Ginecol 2017; 43 (2): 1-9. http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0138-600X2017000200013&lng=es
Habib M, et al. Efficacy of Hematological Indices for β Thalassemia Trait Screening in Pregnant Women. NJHS 2017; 2017 (2): 155-8. doi:10.21089/njhs.24.0155
Roth C, et al. Thalassemia Syndromes in Pregnancy. Nurs Womens Health 2016; 20 (4): 415-20. doi:10.1016/j.nwh.2016.07.008.
Carvajal-Alzate M. Beta-Talasemia: Un mundo de complicaciones con nuevas alternativas de tratamiento. Archivos de Medicina (Col) 2019; 19 (1): 148-159. https://doi.org/10.30554/archmed.19.1.2732.2019
Roumi J, et al. Pregnancy in β-thalassemia intermedia at two tertiary care centers in Lebanon and Italy: A follow-up report on fetal and maternal outcomes. Am J Hematol 2017; 92 (6): E96-9. https://doi.org/10.1002/ajh.24690
Agrawal A, et al. Red Blood Cell Alloimmunization in Multitrasfused Patients: A Bicentric Study in India. Glob J Transfus Med 2016; 1 (1): 12-5. doi:10.4103/2455-8893.178005
Lal A, et al. Transfusion practices and complications in thalassemia. Tranfusion 2018; 58 (12). https://doi.org/10.1111/trf.14875
Amooee D, et al. The pregnancy outcome in patients with minor β-thalassemia. Iran J Reprod Med [en línea]. 2011. 2011; 9 (1): 9-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212139/pdf/ijrm-9-009.pdf
Khan H, et al. Frequency of beta-thallassemia trait among pregnant women in their last trimester with hypochromic microcytic anemia. Pakistan Journal of Public Health 2017; 7 (2): 79-81. https://doi.org/10.32413/pjph.v7i2.37
Voskaridou E, et al. Pregnancy in beta-thalassemia intermedia: 20-year experience of a Greek thalassemia center. EJ Haematol 2014; 93 (6): 492-99. https://doi.org/10.1111/ejh.12387
Bezirgiannidou Z, et al. Hyperhemolytic Syndrome Complicating a Delayed Hemolytic Transfusion Reaction due to anti-P1 Alloimmunization, in a Pregnant Woman with HbO-Arab/β-Thalassemia. Mediterr J Hematol Infect Dis. 2016; 8 (1): 1-5. doi: 10.4084/MJHID.2016.053
Al-Riyami, et al. Risks of red blood cell alloimmunization in transfusion-dependent β-thalassemia in Oman: a 25-year experience of a university tertiary care reference center and a literature review. Transfusion 2018; 58 (4): 871-78. doi:10.1111/trf.14508
Fuenzalida J, Carvajal J. Manejo de la embarazada con isoinmunización por anticuerpos irregulares. Rev chil obstet ginecol 2014; 79 (4): 315-22. http://dx.doi.org/10.4067/S0717-75262014000400011