MPN-221 Management Parameters of Myeloproliferative Neoplasm (MPN) With JAKV617F Mutation During Conception Optimizing the Outcome.

Abstract

Essential thrombocytopenia (ET), polycythemia vera (PV), and myelofibrosis (MF) are heterogeneous groups of clonal hematopoietic cells the major subgroups within MPNs. MPNs can be critical, mainly due to the risk of thrombosis. ET is mainly concerned with increased risk of thrombosis with preserved quality of life, PV affecting both morbidity and also life expectancy; elevated total leucocytic count enhances the TTT with Interferon Alpha due to cytogenetic remission in case of JAKV617F and so pregnancy with MPNs has been reported to be associated with maternal thrombosis, hemorrhage, and placental dysfunction, leading to fetal growth restriction or loss. A retrospective study was held at Ain Shams University (outpatient clinic) and the prenatal care of El Sheik Zayed Al Nahian (MOH). 25 patients aged (18-55) were included 14 patients with ET (56%), 8 patients with PV (32%), 3 patients with MF 12%; those with MF didn't meet the inclusion criteria. Recorded total 118 pregnancies with live birth represented 70% in ET and 62% in PV, 56% spontaneous losses occurred in the first trimester, 24% in the second trimester, and 11% in the third trimester. The aspirin dose was described in all patients with ET and PV with dose 75 mg and was correlated with the pregnancy outcome to show a significant correlation with P>0.5. Low molecular weight (LMWT) heparin was added as a second line in 64% of patients with a significant correlation with pregnancy outcome as regard live birth, P>0.5. Interferon was added in the second trimester in two patients with PV with no impact on the outcome of live birth. Patients with PV continue on aspirin and LMWT heparin (Clexan) postpartum till the end of the puerperium in 4 patients with PV. Incidence of bleeding or thrombosis in patients treated with LMWH vs Aspirin only in the postpartum period showed no significant difference. Preeclampsia was reported in 2 patients 8% and ended in a live birth. To improve outcomes and reduce complications, several strategies have been attempted, including aspirin, heparin, and cytoreductions with interferon.