Pregnancy in survivor of acute lymphoblastic leukemia with thalassemia trait.

Mrs XYZ, a 30-year-old woman, came with complaints of three and half months of amenorrhea. She was G2P1L1 with a previous LSCS done for cephalo pelvic disproportion (CPD). She had presented with symptoms of fatigue, malaise, weakness, and anemia and was referred to a hematologist in 1985. Her hemoglobin was 8 g %, Hematocrit 25 %, total count 75,000, Lymphoblast 88 %, and Platelet 1.6 lacs. Her bone marrow examination revealed total replacement with lymphoblast over 90 %. She was diagnosed as Tcell-type ALL. CT scan brain showed CNS involvement. She received multiple chemotherapy treatments in 1985 and 2,400 rads of radical cobalt radiation to the cranium for metastasis. She developed paralysis following a lumbar puncture in 1986 and developed foot drop and loss of power below the hip, Fig. 1. In the first pregnancy, she had presented with 4 months of amenorrhea. She had presented with pallor. Her hemoglobin was 7.4 g %, with hypochromia and microcytosis on peripheral smear. Her hemoglobin A2 was more than 4.5 %. She was diagnosed with the thalassemia trait. Her husband’s hemoglobin electrophoresis was normal. Her pregnancy was uneventful except at 36 weeks, there was a slight increase in total and direct bilirubin. The total bilirubin was 1.8 and direct was 1 mg %. She was referred to a hematologist and was diagnosed as being on complete remission of ALL with the thalassemia trait to be managed conservatively as no special care would be needed during delivery. Clinical and MRI pelvimetry showed cephalo pelvic disproportion. Elective LSCS was done on November 7, 2006, at K.J Somaiya Hospital. She delivered a 2.9-kg female child who is now 3 years old with no abnormalities at present. In her second pregnancy, she presented with three and half months of amenorrhea. This pregnancy was also uneventful. Only the LFT was deranged. Total bilirubin was 2 mg % and direct was 1.3 mg %. Other investigations were within normal limits. Color Doppler was normal with no oligohydramnios. A hematologist’s reference was done and the patient was fit for LSCS. Elective LSCS was done on January 8, 2010, at K.J.Somaiya Hospital. She delivered a 2.750-kg female child with no congenital anomaly except a club foot. The postoperative recovery was good and the patient was discharged on day 6. Shafi D. (&), Assistant Professor Sathe A. V., Associate Professor Department of Obstetrics and Gynecology, K.J.Somaiya Medical College, Ayurvihar, Everard Nagar, Eastern Express Highway, Sion, Mumbai 400022, India e-mail: [email protected] The Journal of Obstetrics and Gynecology of India (December 2012) 62(S1):S29–S30 DOI 10.1007/s13224-013-0372-8