Acute lymphoblastic leukemia resulting in maternal death : a case report

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  • YOSHIDA Atsushi
    Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University
  • SAWADA Masami
    Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University
  • NUNODE Misa
    Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University
  • DAIMON Atsushi
    Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University
  • NAGAYASU Yoko
    Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University
  • SUGIMOTO Atsuko
    Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University
  • FUJITA Daisuke
    Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University
  • MIYOSHI Takuji
    Department of Internal Medicine(Ⅰ), Faculty of Medicine, Osaka Medical and Pharmaceutical University
  • OHMICHI Masahide
    Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University

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Other Title
  • 急激な経過をたどった急性リンパ性白血病合併妊娠の1例
  • キュウゲキ ナ ケイカ オ タドッタ キュウセイ リンパセイ ハッケツビョウ ガッペイ ニンシン ノ 1レイ

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Abstract

<p>The occurrence of acute leukemia during pregnancy is extremely rare. We report a case of pregnancy came to our hospital with a complaint of epistaxis and was diagnosed with B-cell acute leukemia, and was found to be 17 weeks pregnant at the same time. Since she was in a state of DIC (Disseminated Intravascular Coagulation) with markedly low platelet count and anemia, blood transfusion and chemotherapy were prioritized, and abortion was decided after waiting for improvement of blood data. However, hematopoietic deficiency did not improve, and intrauterine fetal death and rupture of membranes were confirmed at 18 weeks five days gestation, and the stillborn baby was delivered at 19 weeks zero days gestation while blood transfusion to the mother was continued. There was no increased bleeding or intrauterine infection, but her general condition did not improve, and she was pronounced dead on the 16th day after the delivery of the stillborn baby. Acute leukemia should be treated as soon as possible after diagnosis, but in early pregnancy, treatment often results in miscarriage and intrauterine fetal death, and there is often no choice but abortion. However, depending on the medical condition, abortion itself may be risky and may also affect the condition of the leukemia. In some cases, as in this case, treatment of the leukemia should be prioritized and the procedure performed during a lower-risk term. Appropriate decisions regarding the timing of treatment and obstetric procedures for leukemia-complicated pregnancies should be made in collaboration with hematology departments. [Adv Obstet Gynecol, 75(1) : 93-99, 2023 (R5.2)]</p>

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