Management of Early Pregnancy Failure in a Patient with Pancytopenia

Diana Cholakian

doi:10.23937/2377-9004/1410018

Abstract

The safest and most effective therapy for an early pregnancy failure in women with pancytopenia is unknown. Here, we present a case report of a patient diagnosed with a 10-week embryonic demise who had a rare hematologic disorder called TnPolyagglutination syndrome that caused pancytopenia. The patient was offered expectant, medical, or surgical management, and she chose outpatient vaginal misoprostol. A week later, the patient presented to the emergency room with a septic abortion. She was given broad spectrum antibiotics and a suction dilation & curettage was performed. After 72 hours of antibiotic therapy, the patient was discharged home and made a full recovery to baseline. This case suggests that initial surgical management of early pregnancy failure in women with pancytopenia should be considered and strongly recommended over expectant or medical management. We review management options and surgical planning for patients with pancytopenia, regardless of the etiology.

Highlights

Tnpolyagglutination Syndrome (TnP) is a rare hematologic disorder characterized by pancytopenia with multi-lineage dysplasia [1]
At approximately three weeksof age she developed persistent petechiae. It is unknown which diagnostic tests were performed during her childhood, but during adulthood, a serum lectin panel confirmed the diagnosis of pancytopenia caused by Tnpolyagglutination syndrome (TnP)
Outpatient antibiotics were prescribed for severe neutropenia (ANC 486cells/ microliter)

Summary

Introduction

Tnpolyagglutination Syndrome (TnP) is a rare hematologic disorder characterized by pancytopenia with multi-lineage dysplasia [1]. In most cases of TnP, a defect in the synthesis of blood cell membrane glycoproteins (Gb3/CD77) allows exposure of the normally hidden Tn antigen to naturally occurring anti-Tn antibodies, thereby leading to polyagglutination [1,2,3,4]. While TnP is not directly linked to malignancy, case reports of acute leukemia in patients with Tnpolyagglutination syndrome have been published [6]. We present the management of an embryonic demise in a woman with TnP.

Results

Conclusion