PREGNANCY WITH POLYCYTHEMIA VERA - AN OBSTETRIC CHALLENGE
Journal
Macedonian Journal of Anaesthesia
Date Issued
2022
Author(s)
Abstract
Polycythemia vera (PV) is a rare chronic myeloproliferative disorder of the haematopoietic
stem cell type characterized by increased erythrocyte production. The disease is associated to
a high risk of clinical complications - arterial and venous thrombosis, especially in pregnancy,
bleeding, possible evolution to myelofibrosis and acute myeloid leukemia.
We present the case of a 28-years-old patient, whose diagnosis was made 2 years before
pregnancy (positive for mutation JAK2 V617F, bcr-abl negative, MPL, CALR negative). She
was regularly monitored at the Hematology Clinic, had therapeutic venipunctures performed
and anticoagulant therapy was prescribed. Pregnancy was regularly followed, with proper fetal
growth and development, regular screening for fetal abnormalities, under anticoagulant therapy
and under the supervision of a hematologist.
At 34 weeks gestation, due to bleeding and pain, she was hospitalized in the Peripartal
Intensive Care Department suspected of placental abruption. A caesarean section was performed
immediately, a premature fetus was delivered in relatively good condition, and during the
operation abruption of 1/3 of the placenta was found. The operative and postoperative periods
were stable, the patient received replacement therapy and was discharged from the hospital on
the 5th postoperative day in good general condition. The newborn was stabilized and discharged
in good general condition after 3 weeks of stay at the Neonatal Intensive Care Department.
Conclusion: Pregnancy in patients with this disease carries serious risks to the life and
health of both mother and fetus, which requires special attention during pregnancy in order to
reduce antenatal and postnatal morbidity.
stem cell type characterized by increased erythrocyte production. The disease is associated to
a high risk of clinical complications - arterial and venous thrombosis, especially in pregnancy,
bleeding, possible evolution to myelofibrosis and acute myeloid leukemia.
We present the case of a 28-years-old patient, whose diagnosis was made 2 years before
pregnancy (positive for mutation JAK2 V617F, bcr-abl negative, MPL, CALR negative). She
was regularly monitored at the Hematology Clinic, had therapeutic venipunctures performed
and anticoagulant therapy was prescribed. Pregnancy was regularly followed, with proper fetal
growth and development, regular screening for fetal abnormalities, under anticoagulant therapy
and under the supervision of a hematologist.
At 34 weeks gestation, due to bleeding and pain, she was hospitalized in the Peripartal
Intensive Care Department suspected of placental abruption. A caesarean section was performed
immediately, a premature fetus was delivered in relatively good condition, and during the
operation abruption of 1/3 of the placenta was found. The operative and postoperative periods
were stable, the patient received replacement therapy and was discharged from the hospital on
the 5th postoperative day in good general condition. The newborn was stabilized and discharged
in good general condition after 3 weeks of stay at the Neonatal Intensive Care Department.
Conclusion: Pregnancy in patients with this disease carries serious risks to the life and
health of both mother and fetus, which requires special attention during pregnancy in order to
reduce antenatal and postnatal morbidity.
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