Pregnancy Induced Hemolytic Anemia in an Antenatal Mother A Rare Case Report

In an antenatal mother, pregnancycan exacerbate the underlying autoimmune hemolytic anemia. The features of anemia becomes apparent in third trimester, remits completely within 2 months of delivery, recurs in subsequent pregnancy and it may be severe and life threatening. The autoimmune hemolytic anemia may be due to warm antibodies, cold antibodies or due to biphasic antibody known as Donath-landsteiner antibody.Case Report 30 year old antenatal mother with 22 weeks of amenorrhea, G3P2L1Al, was referred to the hematology department with a known history of hemolytic anaemia in previous pregnancies. She gave the history of jaundice and abortion at the 20th week of first gestation. During her second gravida also she developed evidence of hemolysis at 24th week of her pregnancy, for which she was investigated and diagnosed to have autoimmune hemolytic anemia. In the present pregnancy (3rd Gravida), at 22nd week her DAT, IAT and auto control were positive. The eluate was prepared and screened with panel cells, which showed the presence of anti-c antibody. Fathers and first childs blood were phenotyped and found to be c antigen negative. She was on corticosteroids and transfused c antigen negative least incompatible packed red cell units. She was transfused with around 12 units c antigen negative coombs compatible packed red blood cell during her entire gestation and her hemoglobin level was maintained at 7 gm. At term she delivered a healthy female child. Her subsequent follow up once in a month for up to 6 months was uneventful.Conclusion Pregnancy induced hemolytic anemia in an antenatal mother is very rare, unlike Hemolytic Disease of Fetus and Newborn. However, it can cause clinically significant hemolysis endangering both mother and fetus. The existence of such rare condition which appears during pregnancy and disappears following delivery has to be considered as one of the differential diagnosis in Hemolytic Anemia of Pregnancy.