Pregnancy with Polycythemia Vera: A Case Report and Review of Literature

Abstract

Polycythemia vera is a form of myeloproliferative disease common in sixth and seventh decade and more in males than in females.Occurrence of MPD with pregnancy is rare. Hence, this case is reported. She was diagnosed as polycythemia vera at the age of 28 yearsand platelet count was 1082 x 109L. She was under treatment and needed phlebotomy 2 to 3 times a year. Pregnancy was natural 2 yearsafter diagnosis of MPD. During pregnancy, platelet count remained 8 to 9 x 109L with aspirin. LMWH was started at 28 weeks of gestation.Although, she was advised elective LSCS at 37 weeks; 2 days prior to LSCS, she went into spontaneous labor. Last dose of aspirin andLMWH was given just 18 hours before labor. She was delivered by emergency LSCS. Fortunately, there was no excess bleeding duringsurgery. The lactation was suppressed.All cases of polycythemia vera with pregnancy should be monitored by joint care of hematologist and obstetrician. In high risk cases,drug therapies like Interferon, Hydroxy urea, Busulfan and Anagrelide can be used.Since unexplained fetal loss is known, elective LSCS is recommended at 34 and 37 weeks of gestation. Modern therapy has significantlyextended the life expectancy. The discovery of JAK2V617F mutation has revolutionized the field of MPDs. Furthur research is necessary.