Aplastic Anemia in Pregnancy - a Single Centre, North American Case Series

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3909-3909 ◽  
Author(s):  
Kelly E McGowan ◽  
Ann Kinga Malinowski ◽  
Andre C. Schuh ◽  
Nadine Shehata
Keyword(s):  
Bone Marrow ◽  
Aplastic Anemia ◽  
North American ◽  
Clinical Presentation ◽  
Post Partum ◽  
First Trimester ◽  
Mount Sinai Hospital ◽  
Newly Diagnosed ◽  
Single Centre ◽  
In Pregnancy

Abstract Introduction Little data exist on the clinical presentation, management and treatment of aplastic anemia (AA) in pregnancy.The aim of this study is to describe the clinical presentation, management and outcomes of patients with AA in pregnancy based on a single centre, North American experience. Methods Patients with AA during pregnancy managed at Mount Sinai Hospital, a tertiary care centre in Toronto, Canada, were retrospectively identified through the Special Pregnancy Program database from 1990 to 2014, inclusive. Charts and electronic medical records were reviewed to extract demographics, clinical features, bone marrow biopsy results, paroxysmal nocturnalhemoglobinuria(PNH) status, comorbidities, treatment and transfusion requirements, as well as obstetrical and post-partum outcomes.The Research Ethics Board at Mount Sinai Hospital approved the study. Results Between 1990 and 2014, 24 pregnancies were identified in 12 women with AA. Among these, 3 women (5 pregnancies) were excluded from subsequent analysis due to incomplete records. Among the 19 pregnancies in 9 women with AA, 6 women had at least one subsequent pregnancy during the study period. The initial diagnosis of AA occurred during pregnancy in 5 of the 19 pregnancies in 9 women (Table 1). Four of the 5 women were diagnosed with AA in the first trimester. The presenting signs and symptoms included fatigue (1), chest pain due to severeanemia(1),petechiae(1), hematemesis (1) and in 1 patient the diagnosis was made following a CBC performed for routine prenatal care. Among the 14 pregnancies with a prior diagnosis of AA, 4 were in complete remission (CR) and 6 were in partial remission (PR). In addition, there were 5 pregnancies in 3 women following allogeneic bone marrow transplant (alloBMT). Of these, 3 pregnancies occurred post-alloBMTin CR, 1 in PR and 1 was not in remission. PNH clones were present in 4 of the pregnancies (3 women). Among the 5 pregnancies with newly diagnosed AA, 3 were treated with cyclosporine during pregnancy and 1 was treated with prednisone alone, all without a response. Transfusion support was required in 10 of the 19 pregnancies, including all 5 pregnancies with newly diagnosed AA (Table 2). In the 5 pregnancies with newly diagnosed AA, the median haemoglobin was 67g/L, median WBC was 3.6/microLand median platelet count was 26x109/L at the time of diagnosis. In the 14 pregnancies with a prior diagnosis of AA, the median haemoglobin, WBC and platelet counts in the first trimester were higher (Table 2). Although there were no maternal deaths, significant complications occurred in 15 of the 19 (79%) pregnancies (Table 3). Four pregnancies (in two women) were not associated with significant complications and these patients were in PR or CR at the onset of pregnancy. Common complications during pregnancy and post-partum included transfusion-related event (13), drug adverse effect (8), bleeding (6), preterm birth (5), thrombosis (3) and infection (3) (Table 3). Most of the pregnancies experienced declining hematologic parameters over the course of pregnancy. However, relapses were not observed among the 10 pregnancies in CR or PR at onset of pregnancy. There were no spontaneous remissions of AA in the postpartum period. Among the 5 women with newly diagnosed AA in pregnancy, 3 underwentalloBMTand 2 had excellent outcomes with resolution ofcytopeniasand no complications. The third woman who underwentalloBMTsuffered significant complications following transplantation including disseminatedNocardia(brain and lung), renal dysfunction secondary to cyclosporine, acute GVHD of the gastrointestinal tract and liver, pericarditis, iron overload and transfusion dependency. Conclusions AA in pregnancy is rare, with 24 pregnancies in 12 women over 24 years in a single, tertiary hospital. AA in pregnancy was not associated with mortality but significant morbidity was seen. In our cohort, no spontaneous remissions of AA were observed post-partum. Further studies with larger sample sizes are required to clarify the natural history of AA in pregnancy and best approach to management to avoid complications during pregnancy and post-partum. Disclosures Schuh: Amgen: Membership on an entity's Board of Directors or advisory committees.

Antithrombin Deficiency in Pregnancy.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1879-1879
Author(s):  
Retter J. Andrew ◽  
Hunt J. Beverley
Keyword(s):  
Caesarean Section ◽  
Post Partum ◽  
Case Series ◽  
Fold Increase ◽  
First Trimester ◽  
Antithrombin Deficiency ◽  
Sagittal Sinus ◽  
Asymptomatic Patients ◽  
Estimated Blood Loss ◽  
In Pregnancy

Abstract Background: During pregnancy untreated antithrombin deficiency is associated with up to a 50% risk of venous thromboembolism (VTE) and a relative risk of pregnancy loss of 2.1 with a 5-fold increase in stillbirths. Thus thromboprophylaxis is widely used, but little data is available to select type, dose & duration of anticoagulation. Method: We performed a retrospective, single centre observational study of our antithrombin deficient pregnancies since 1996. Results: There were 9 pregnancies in 8 women; median age at conception 33 (age-range 19–37). They separated into 3 groups (1) 4 asymptomatic patients diagnosed on family screening. They received unmonitored enoxaparin 40mg until 16 weeks then 40mg BD. (2) 2 with previous VTE, received intermediate dose enoxaparin (1mg/kg), increased to BD at 16 weeks. Monitoring was done to maintain an anti-Xa trough of <0.12 iu/ml and peak <0.8iu.ml. (3) 2 referred after presenting with VTE in pregnancy. They received enoxaparin 1mg/kg BD and the same monitoring These included a known antithrombin deficient woman, referred in her second pregnancy at 26weeks gestation with premature rupture of the membranes and an iliofemoral deep vein thrombosis which developed on enoxaparin 60mg OD. Enoxaparin was increased to 1mg/kg BD and an IVC filter inserted. Despite the filter however she had a pulmonary embolism. The filter was removed after Caesarean section at 31 weeks. Two had sagittal sinus thromboses in the first trimester associated with severe hyperemesis requiring IV fluids. One was our only thromboprophylaxis failure, receiving enoxaparin 40mg OD, she weighed 80Kg. The second presented at 11weeks gestation. She was intolerant of self injecting and so switched to warfarin at 15 weeks until 35 weeks as did one other mother. All mothers had close feto-maternal monitoring with uterine artery Doppler at 24 weeks if possible and then monthly growth scans thereafter. Delivery: Thromboprophylaxis was stopped at labour initiation or 12hrs prior to Caesarean section (3 women) and 50iu/kg of antithrombin concentrate was given. Anticoagulation was restarted 24hrs after delivery. Six weeks enoxaparin post-partum thromboprophylaxis was given or the women converted back to warfarin. Estimated blood loss at delivery was a median of 200ml (range 200–500ml), no transfusions were required. There were no post partum VTEs. Nine births occurred at a median gestation of 38weeks (range 31–41), median birth weight 3045g (range 1420–4120g). One child has West’s syndrome. Conclusion: This is the largest case series on the management of antithrombin deficiency in pregnancy. The combined use of enoxaparin in pregnancy and post partum combined with antithrombin concentrate during labour appears to improve pregnancy outcome and reduce the rate of VTE. Larger studies are required to confirm this finding.

scholarly journals Management of Aplastic Anemia in Pregnancy: A Case Report

2020 ◽  
pp. 125-128
Author(s):  
Suskhan Djusad ◽  
Yoarva Malano
Keyword(s):  
Bone Marrow ◽  
Risk Factor ◽  
Case Report ◽  
Aplastic Anemia ◽  
Blood Bank ◽  
Intrauterine Death ◽  
Inherited Disorders ◽  
High Incidence ◽  
Fetal Complications ◽  
In Pregnancy

Aplastic anemia was first recognized by Ehrlich in 1888, although the pathogenesis of aplastic anemia has remained elusive. Aplastic anemia is a subtype of anemia characterized by pancytopenia and a hypocellular bone marrow which are the risk factor can be due to chemicals, drugs, infections, irradiation, leukemia, and inherited disorders. There is universal agreement that pregnancy complicated by aplastic anemia is a serious condition. The risk to the mother is mainly in the form of hemorrhage meanwhile the fetus may suffer from growth restriction and even intrauterine death. Most of the fetal complications are due to maternal anemia. We here present one cases of pregnancy complicated by aplastic anemia, which were seen within 3 months at our hospital. This high incidence is because the hospital is a top national care referral unit with good hematology and blood bank support. Keyword: aplastic anemia, pregnancy, pancytopenia Abstrak Anemia aplastik pertama kali dikenali oleh Ehrlich pada tahun 1888, walaupun patogenesis anemia aplastik masih sulit dipahami. Anemia aplastik adalah subtipe anemia yang ditandai dengan pansitopenia dan hiposeluler sumsum tulang yang merupakan faktor risiko yang dapat disebabkan oleh bahan kimia, obat-obatan, infeksi, iradiasi, leukemia, dan kelainan bawaan. Terdapat kesepakatan universal bahwa komplikasi kehamilan berupa anemia aplastik merupakan kondisi serius. Risiko kepada ibu hamil terutama dalam bentuk perdarahan sementara janin dapat mengalami hambatan dalam pertumbuhan dan bahkan kematian dalam kandungan. Sebagian besar komplikasi janin disebabkan oleh anemia pada maternal. Kami di sini menyajikan satu kasus komplikasi kehamilan berupa anemia aplastik, yang ditemukan dalam waktu 3 bulan di rumah sakit kami. Kejadian yang tinggi ini karena rumah sakit adalah unit rujukan perawatan nasional teratas dengan hematologi yang baik dan dukungan bank darah.

scholarly journals EFEKTIVITAS PEMBERIAN PISANG AMBON DAN VITAMIN B UNTUK MENURUNKAN HIPEREMESIS GRAVIDARUM DI BPM ENDAH BEKTI

2018 ◽  
Vol 7 (1) ◽  
pp. 17-21
Author(s):  
Elvika Fit Ari Shanti ◽  
Liberty Barokah ◽  
Budi Rahayu
Keyword(s):  
Pregnant Women ◽  
Vitamin B6 ◽  
Hyperemesis Gravidarum ◽  
Post Partum ◽  
Endocrine System ◽  
First Trimester ◽  
The Other ◽  
Vitamin B ◽  
Difference Test ◽  
In Pregnancy

Background: Endocrine system changes during pregnancy are important to keep the pregnancy, fetal growth and post partum recovery. Around 50-90% of pregnant women experience vomit and nausea. To solve those problems, ‘pisang ambon’ (Musa paradisiacal) consumption is one of choices because of its flavonoid and vitamin B6 which can overcome vomit and nausea in pregnancy. Objective: The aim of this research was to identify the effectiveness between pisang ambon (Musa paradisiacal) consumption and vitamin B6 to reduce hyperemesis gravidarum in BPM Endah Bekti. Methods: A quasy experimental design with two-group posttest only was assigned to 20 pregnant women on their first trimester. First ten sample was given vitamin B6 and the other ten sample were given vitamin B6 plus pisang ambon. Data were then analyzed using two independent mean difference test. Results: The result shows that in vitamin B6 consumption for hyperemesis gravidarum in 10% pregnant women were in the effective category. While in the pisang ambon consumption shows 100% of pregnant women are in the effective category. Conclusion: There is difference in effectiveness between vitamin B6 and pisang ambon consumption to overcome hyperemesis gravidarum (p=0,003<α).   Keywords: Hiperemesis gravidarum, vitamin B6, Pisang ambon

scholarly journals AB0424 PREDICTORS OF SLE FLARE-UP AND PREMATURE DELIVERY IN PREGNANCY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1511.1-1512
Author(s):  
C. H. Liao ◽  
L. C. Wang ◽  
S. C. Hsieh ◽  
B. L. Chiang
Keyword(s):  
Serum Albumin ◽  
Serum Albumin Level ◽  
Post Partum ◽  
First Trimester ◽  
Albumin Level ◽  
Complement C3 ◽  
Premature Delivery ◽  
Disease Flare ◽  
In Pregnancy ◽  
Low Serum

Background:Systemic lupus erythematosus (SLE) is a life-threatening autoimmune disease that affects many women of child-bearing age, with potentially severe consequences on pregnancy outcome. SLE flare-ups may occur during pregnancy and the post-partum period. Previous studies documenting the incidence and risk factors of flare-up of SLE during pregnancy and puerperium had partially discordant results.Objectives:We aimed to delineate the pregnancy complications of women with SLE, as well as neonatal outcomes of their offspring, and hoped to clarify the incidence and risk factors of SLE flare-ups during pregnancy and puerperium.Methods:We retrospectively reviewed the medical records of SLE patients with previous records of pregnancies in our institution. Flare events during pregnancy and puerperium were documented. The pregnancy outcomes recorded include live births, intra-uterine fetal death (IUFD), premature delivery (< 36 weeks of gestational age), NICU admission, and small for gestational age (SGA, <10thpercentile). Univariate logistic regression was performed to determine the factors associated with disease relapse and pregnancy outcomes.Results:From January, 2000 to December, 2019, a total of 94 SLE patients with 139 pregnancies were identified. The overall live birth rate was 92.4% (134/145). Forty-six (34.3%) of the neonates were delivered prematurely. Forty-six (34.3%) of them were SGA. The admission rate to the neonatal intensive care unit was 25% (30/120). Nine (6.4%) were diagnosed to have SLE during pregnancy. The flare rate during pregnancy was 20% while post-partum 9.4%. The majority of the relapses during pregnancy occurred in the second trimester (46.2%), followed by the first trimester (30.8%), and the third trimester (23.1%). Low complement C3 (C3 < 80mg/dl), thrombocytopenia (PLT < 100*103/uL) at conception, and low serum albumin level at the first trimester were associated with antepartum flare. Presence of disease flare and pre-eclampsia in pregnancy, and low serum albumin level at conception were significantly associated with premature delivery.Conclusion:Low complement C3 and thrombocytopenia at conception, and low serum albumin level at the first trimester were associated with disease flare-up during pregnancy. Patients with relative low serum albumin level at conception, or presence of eclampsia or disease flare-up during pregnancy had a higher risk of premature delivery.References:[1]Shaharir SS, Mohamed Said MS, Mohd R, et al. Predictors of SLE relapse in pregnancy and post-partum among multi-ethnic patients in Malaysia.PloS one2019;14(9):e0222343.[2]Bundhun PK, Soogund MZ, Huang F. Impact of systemic lupus erythematosus on maternal and fetal outcomes following pregnancy: A meta-analysis of studies published between years 2001-2016.Journal of autoimmunity2017;79:17-27.Disclosure of Interests: :None declared

Changes of Intracellular Signal Pathway of mTOR/S6 in T Cells of Refractory/Relapsed Aplastic Anemia

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4110-4110
Author(s):  
Guangsheng He ◽  
Xiang Zhang ◽  
Wu Depei ◽  
Mingqing Zhu ◽  
Aining Sun
Keyword(s):  
Bone Marrow ◽  
T Cells ◽  
Aplastic Anemia ◽  
Cd8 T Cells ◽  
Signal Pathway ◽  
Deficiency Anemia ◽  
Newly Diagnosed ◽  
Ifn Γ ◽  
Intracellular Signal ◽  
Normal Controls

Abstract Objects: To explore the activation state of intracellular signal pathway of mTOR/S6 in refractory/relapsed aplastic anemia (AA); the effect of rapamycin (RAPA) and CTLA-4 immunoglobulin (CTLA-4Ig) on this signal pathway in refractory/relapsed AA. Methods: Samples were collected from 13 refractory/relapsed AA patients [male: 6, female: 7, media age: 27 years (from 7 to 66years)], 8 newly diagnosed patients with severe aplastic anemia (SAA) [male: 5, female: 3, media age: 21.5 years (from 12 to 58 years)]. The intracellular percentages of p-mTOR, p-S6 and IFN-γ of CD3+, CD3+CD8+ and CD3+CD8− T cells in bone marrow were detected by flow cytometry (FCM). 10 iron deficiency anemia (IDA) patients [male: 3, female: 7, media age: 44 years (from 31 to 72 years)] were determined as case controls and normal controls respectively. After exposure to RAPA and CTLA-4Ig respectively, samples were detected by FCM for the expression of p-mTOR, p-S6 and IFN-γ in CD3+, CD3+CD8+ and CD3+CD8− T cells in bone marrow, in order to estimate the effect of RAPA and CTLA-4Ig on the pathway of mTOR/S6 in refractory/relapsed AA. Results: In refractory/relapsed AA, measurement of p-mTOR, p-S6 and IFN-γ in CD3+, CD3+CD8− and CD3+CD8+ T cells were (42.42±26.44)%, (44.38±24.95)%, (51.89±27.00)%; (6.47±2.72)%, (9.16±2.89)%, (9.61±5.34)%; (18.87±10.05)%, (13.17±5.88)%, (20.07±15.16)%, respectively; and showed an increased level compared to normal controls [(1.54±1.51)%; P=0.000], [(1.94±1.08)%; P=0.000], [(2.04±2.03)%; P=0.000]; [(0.83±0.82)%; P=0.000], [(0.91±0.88)%; P=0.000], [(0.95±0.93)%; P=0.000]; [(4.42±3.55)%; P=0.000], [(2.35±1.69)%; P=0.000], [(4.73±4.43)%; P=0.004]. In newly diagnosed patients with SAA, the levels of p-mTOR and p-S6 in CD3+, CD3+CD8− and CD3+CD8+ T cells were (1.71±1.66)%, (2.28±2.15)%, (1.59±1.52)%; (1.23±1.13)%, (1.23±1.07)%, (1.76±1.68)% respectively, and they were similar to normal controls (P&gt;0.05), but significantly lower than those of refractory/relapsed AA (P&lt;0.01). Expression of IFN-γ in CD3+, CD3+CD8− and CD3+CD8+ T cells was higher than normal controls with (10.38±3.83)%, (6.11±1.91)%, (13.14±7.05)% (P&lt;0.01). The percentages of CD3+IFN-γ+ and CD3+CD8−IFN-γ+ were lower than refractory/relapsed AA (P&lt;0.05), while it was comparable for CD3+CD8+IFN-γ+ cells between the two groups (P&gt;0.05). Exposed to RAPA, the expression of p-mTOR, p-S6 and IFN-γ in CD3+, CD3+CD8− and CD3+CD8+ T cells decreased markedly (P&lt;0.05) to (12.44±12.41)% (12.60±12.57)%, (16.85±15.64)%; (1.49±1.45)%, (1.46±1.43)%, (1.55±1.54)%; and (4.29±4.23)%, (3.16±3.32)%, (10.70±10.63)% in refractory/relapsed AA. And treated with CTLA-4Ig could also cause a significant reduction of p-mTOR, p-S6 and IFN-γ in CD3+, CD3+CD8− and CD3+CD8+ T cells, which were (6.40±6.13)%, (8.32±7.76)%, (7.18±7.02)%; (1.08±1.08)%, (2.69±2.37)%, (1.60±1.56)%; (1.67±1.60)%, (2.39±2.12)%, (1.30±1.30)%, respectively, (P&lt;0.01). Conclusions: In refractory/relapsed AA, the signal pathway of mTOR/S6 was activated, and it was quiescent in normal controls and newly diagnosed patients with SAA. The expression of p-mTOR, p-S6 and IFN-γ of this signal pathway in refractory/relapsed AA could be suppressed by RAPA or CTLA-4Ig. The signal pathway of CD28/mTOR/S6/IFN-γ might take part in immune pathogenesis of refractory/relapsed AA, and was sensitive to RAPA and CTLA-4Ig. It was worth exploring the clinical values of the two drugs.

scholarly journals Aplastic anaemia in pregnancy - a single centre, North American series

2018 ◽  
Vol 184 (3) ◽  
pp. 436-439 ◽  
Author(s):  
Kelly E. McGowan ◽  
Ann K. Malinowski ◽  
Andre C. Schuh ◽  
Wendy Whittle ◽  
Nadine Shehata
Keyword(s):  
Aplastic Anaemia ◽  
North American ◽  
Single Centre ◽  
Anaemia In Pregnancy ◽  
In Pregnancy

scholarly journals Insulinoma in pregnancy (a case presentation and systematic review of the literature)

Rare Tumors ◽  
2021 ◽  
Vol 13 ◽  
pp. 203636132098664
Author(s):  
Eva M Dobrindt ◽  
Martina Mogl ◽  
Peter E Goretzki ◽  
Johann Pratschke ◽  
Agata K Dukaczewska
Keyword(s):  
Systematic Review ◽  
Early Pregnancy ◽  
Clinical Presentation ◽  
Post Partum ◽  
Clinical Signs ◽  
Hyperinsulinemic Hypoglycemia ◽  
Second Trimester ◽  
Review Of The Literature ◽  
Case Presentation ◽  
In Pregnancy

Insulinomas are rare, benign and functional tumors that coincidentally may become overt during pregnancy or in the post-partum period. As the general symptoms of a pregnancy might cover the clinical presentation, diagnosing remains challenging. We present one additional case of a post-partum insulinoma, combined with a systematic review of the literature to sum up relevant details in diagnosis and treatment. A systematic request of Pubmed/Medline was conducted using the following terms: “insulinoma AND pregnancy” and “insulinoma” for a second request of ClinicalTrials.gov. All publications concerning pregnant or post-partum women with insulinoma were included. Thirty-six cases could be identified for analysis. Each publication was reviewed for demographic, diagnostic and therapeutic data. The most frequent clinical signs were unconsciousness and neurological symptoms. 64.9% were diagnosed during early pregnancy and 35.1% post-partum. 91.9% underwent surgery with a third resected during pregnancy without severe influence on fetal or maternal outcome. Three patients died of metastatic disease or misdiagnosing, two of them miscarried. Insulinoma in pregnancy is rare but should be considered in case of unclear hyperinsulinemic hypoglycemia. Surgery can be performed during the second trimester or post-partum with promising outcome.

scholarly journals EFEKTIVITAS PEMBERIAN PISANG AMBON DAN VITAMIN B UNTUK MENURUNKAN HIPEREMESIS GRAVIDARUM DI BPM ENDAH BEKTI

2019 ◽  
Vol 7 (1) ◽  
pp. 17-21
Author(s):  
Elvika Fit Ari Shanti ◽  
Liberty Barokah ◽  
Budi Rahayu
Keyword(s):  
Pregnant Women ◽  
Vitamin B6 ◽  
Hyperemesis Gravidarum ◽  
Post Partum ◽  
Endocrine System ◽  
First Trimester ◽  
The Other ◽  
Vitamin B ◽  
Difference Test ◽  
In Pregnancy

Background: Endocrine system changes during pregnancy are important to keep the pregnancy, fetal growth and post partum recovery. Around 50-90% of pregnant women experience vomit and nausea. To solve those problems, ‘pisang ambon’ (Musa paradisiacal) consumption is one of choices because of its flavonoid and vitamin B6 which can overcome vomit and nausea in pregnancy. Objective: The aim of this research was to identify the effectiveness between pisang ambon (Musa paradisiacal) consumption and vitamin B6 to reduce hyperemesis gravidarum in BPM Endah Bekti. Methods: A quasy experimental design with two-group posttest only was assigned to 20 pregnant women on their first trimester. First ten sample was given vitamin B6 and the other ten sample were given vitamin B6 plus pisang ambon. Data were then analyzed using two independent mean difference test. Results: The result shows that in vitamin B6 consumption for hyperemesis gravidarum in 10% pregnant women were in the effective category. While in the pisang ambon consumption shows 100% of pregnant women are in the effective category. Conclusion: There is difference in effectiveness between vitamin B6 and pisang ambon consumption to overcome hyperemesis gravidarum (p=0,003<α). Keywords: Hiperemesis gravidarum, vitamin B6, Pisang ambon

scholarly journals Extra-Axial Hematoma and Trimethoprim-Sulfamethoxazole Induced Aplastic Anemia: The Role of Hematological Diseases in Subdural and Epidural Hemorrhage

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Richard P. Menger ◽  
Rimal H. Dossani ◽  
Jai Deep Thakur ◽  
Frank Farokhi ◽  
Kevin Morrow ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Aplastic Anemia ◽  
Subdural Hematoma ◽  
Epidural Hematoma ◽  
Clinical Presentation ◽  
Rare Complication ◽  
Intracranial Hematoma ◽  
Hematological Diseases ◽  
Epidural Hemorrhage

Objective and Importance. To illustrate the development of spontaneous subdural hematoma secondary to aplastic anemia resulting from the administration of trimethoprim-sulfamethoxazole. This is the first report of trimethoprim-sulfamethoxazole potentiating coagulopathy leading to any form of intracranial hematoma.Clinical Presentation. A 62-year-old female developed a bone marrow biopsy confirmed diagnosis of aplastic anemia secondary to administration of trimethoprim-sulfamethoxazole following a canine bite. She then developed a course of waxing and waning mental status combined with headache and balance related falls. CT imaging of the head illustrated a 3.7 cm×6.6 mm left frontal subdural hematoma combined with a 7.0 mm×1.7 cm left temporal epidural hematoma.Conclusion. Aplastic anemia is a rare complication of the administration of trimethoprim-sulfamethoxazole. Thrombocytopenia, regardless of cause, is a risk factor for the development of spontaneous subdural hematoma. Given the lack of a significant traumatic mechanism, this subset of subdural hematoma is more suitable to conservative management.

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