Pregnant individuals with blood conditions such as immune thrombocytopenia (ITP), fetal and neonatal alloimmune thrombocytopenia (FNAIT), acute leukemia or aplastic anemia face a significantly higher risk of life-threatening complications, according to a study published recently in The Journal of Obstetrics and Gynecology of India.
These diseases were the leading hematologic causes of maternal near-misses and deaths over a 16-year period in Southern Thailand. Immune thrombocytopenia was the most common, especially when platelet levels fell below 50×10⁹/L.
“[T]he predominant hematologic diseases linked to maternal near misses and mortality were immune thrombocytopenia, acute leukemia and aplastic anemia,” the authors wrote. “Acute leukemia was the leading cause of death. Notably, women with a platelet count of <50× 109/L experienced a higher incidence of severe maternal complications.”
Researchers reviewed 109 cases from 2006 to 2021 at a single quaternary referral center. Among these, 104 women experienced maternal near-misses and five died. These cases made up 7.3% of all maternal near-misses and 7.4% of maternal deaths during that time. Acute leukemia was the deadliest, claiming three lives. Of the 75 patients with ITP, one died after her platelet count dropped to just 6×10⁹/L and she suffered a fatal brain bleed.
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Overall, the median patient age was 29, and more than half were multiparous. Nearly 49% of hematologic disorders were diagnosed before pregnancy, yet many still lacked effective treatment or planning. At the time of delivery or termination of pregnancy, 75% of patients needed platelet transfusions. Severe complications—such as respiratory failure, critical care admission, splenectomy or even hysterectomy—occurred in over half the cases.
In immune thrombocytopenia, women with platelet counts below 50×10⁹/L were significantly more likely to suffer major complications compared to those with higher counts. Still, only some received treatments such as corticosteroids, intravenous immunoglobulin or splenectomy. These findings point to gaps in both early treatment and preconception counseling.
Patients with acute leukemia faced even more daunting challenges. Those who delayed or declined treatment often developed sepsis and died shortly after diagnosis. Though some delivered their babies safely before starting chemotherapy, others could not be saved. Aplastic anemia posed fewer immediate threats, particularly in women whose disease was well controlled before pregnancy.
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