1/14. Twenty-four cordocenteses in one woman.We report on 2 consecutive pregnancies in a woman with a history of neonatal death secondary to Rhesus alloimmunization. Her first subsequent pregnancy was complicated by fetal hydrops at 20 weeks of gestation. The fetus received a total of 11 intrauterine transfusions, and was delivered at 38 weeks. In the patient's next pregnancy, the fetus developed hydrops at 18 weeks of gestation. Thirteen intrauterine transfusions were given to correct fetal anemia, and a healthy baby was delivered at 38 weeks of gestational age. Continuation of intravascular transfusion therapy may represent a reasonable alternative to selective premature delivery even in cases with highly aggressive maternal Rhesus alloimmunization.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
2/14. pregnancy induced hemolytic anemia: an unexplained entity.We present the case of a young primigravida who developed severe life threatening hemolytic anemia in the last trimester of three successive pregnancies with spontaneous recovery after each delivery and remained normal during the entire nongravid state. Corticosteroid and high-dose intravenous immunoglobulin therapy, although reported as useful, was ineffective in our case. She was managed only with the support with top-up blood transfusions. Extensive investigations were carried out to determine the cause of hemolysis, but these proved unfruitful. Fewer than two scores of such cases have been described in the literature. The paucity of such cases merits its presentation. It is suggested that this anemia should be referred to as "pregnancy-induced hemolytic anemia."- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
3/14. recurrence of microangiopathic hemolytic anemia after apparent recovery from the hellp syndrome. A case report.BACKGROUND: The syndrome of hemolytic anemia, elevated liver enzymes and low platelets (HELLP) can accompany preeclampsia and eclampsia. Delivery of the infant usually results in improvement in the mother's condition, with the recovery time dependent on the severity of the disease. We report a case of eclampsia with the hellp syndrome in which microangiopathic hemolytic anemia (MAHA) and thrombocytopenia recurred after apparent recovery. CASE: A 28-year-old woman, gravida 4, para 0, therapeutic abortion 3, presented with signs and symptoms of severe preeclampsia and became eclamptic. The patient's condition improved as expected following cesarean delivery. However, the hemolytic anemia recurred and was successfully treated with a course of fresh frozen plasma (FFP). CONCLUSION: Hemolytic anemia in women with eclampsia and the hellp syndrome occurs secondary to microvascular endothelial damage. In this case resolution of the hellp syndrome and eclampsia occurred, as expected, in two to three days; however, MAHA and low platelets recurred on day 4. Treatment of MAHA with FFP was successful.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
4/14. cefotetan-induced immune hemolytic anemia following prophylaxis for cesarean delivery.Second- and third-generation cephalosporins, notably cefotetan, are increasingly implicated in severe, sometimes fatal immunemediated hemolytic anemia. We describe a 26-year-old woman who developed severe hemolytic anemia 2 weeks after receiving a single prophylactic dose of cefotetan during cesarean delivery. The patient's DAT was weakly reactive for IgG and her serum reacted with cefotetan-coated RBCs. The antibody had a titer of 4,096 by antiglobulin testing. The patient required treatment with two units of PRBCs and experienced gradual resolution of hemolysis. Our case emphasizes the need for increased awareness of delayed onset hemolytic anemia following prophylactic use of cefotetan.- - - - - - - - - - ranking = 5keywords = delivery (Clic here for more details about this article) |
5/14. Evaluation of pulse oximetry in anemia from hemoglobin-H disease.A patient with hemoglobin-H (Hb-H) disease developed an acute hemolytic crisis after treatment with trimethoprim and sulfamethoxazole. Despite her poor clinical condition and profound anemia (Hb, 2.7 g/dL), pulse oximetry continued to demonstrate a high O2 saturation percentage. Manipulation of beer's law shows that anemia theoretically should not affect pulse oximetry values. The literature describes the effects of dyshemoglobinopathies such as carboxyhemoglobinemia and methemoglobinemia on O2 saturation percentage measured by pulse oximetry, but the effect of genetic hemoglobinopathies on pulse oximetry values is largely unreported. Because most hemoglobinopathies do not significantly change the protein-heme electronic interaction, the values of O2 saturation percentage determined through pulse oximetry should remain clinically valid. Hb-H is an exception to this generalization; as in patients with carboxyhemoglobinemia, pulse oximetry measurements showing high O2 saturation percentage do not correspond to high levels of oxygen available for delivery to tissues.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
6/14. Fulminant hepatic failure during perinatal period in a pregnant woman with Wilson's disease.Wilson's disease associated with hepatic failure is not common and the underlying mechanism triggering the event is not known at present. We treated a 28-year-old Japanese woman with Wilson's disease who developed hepatic failure associated with hemolytic crisis just after delivery. She was diagnosed as having Wilson's disease at 12 years of age, at which time she started taking D-penicillamine. She had previously delivered two children without difficulty. When she found out she was pregnant this time, she stopped taking D-penicillamine in contrast to taking it faithfully during her first two pregnancies. On the day of delivery of her full-term baby, jaundice developed accompanied with severe hemolytic crisis. Plasma exchanges and blood transfusion were performed and D-penicillamine administration was started again. She gradually recovered and apparently was following a good clinical course. However, on day 30 the second hemolytic crisis occurred and subsequent liver failure led her to death on day 50. At autopsy her liver was cirrhotic and showed massive necrosis. Prophylactic oral administration of D-penicillamine and careful observation are therefore recommended to prevent hemolytic crisis during the perinatal period.- - - - - - - - - - ranking = 2keywords = delivery (Clic here for more details about this article) |
7/14. plasma exchange for preeclampsia. I. Postpartum use for persistently severe preeclampsia-eclampsia with hellp syndrome.The postpartum use of plasma exchange with fresh-frozen plasma was assessed in a group of seven women with severe preeclampsia-eclampsia and hellp syndrome (hemolysis, elevated liver enzymes, and low platelet count) that persisted greater than 72 hours after delivery. During the study interval in which a total of 107 gravid women with hellp syndrome were seen in our referral center, these seven patients (6.5%) demonstrated persistent thrombocytopenia (platelet count usually less than 30,000/mm3), rising lactic dehydrogenase (greater than 1000 IU/L) and evidence of multiorgan dysfunction. The seven case histories emphasize the variety of clinical and laboratory profiles that can be encountered in this small group of gravid women at risk for severe morbidity or mortality. Up to three 3 L plasma exchanges were required to effect permanent disease arrest and reversal. Utilization of the IBM 2997 Cell Separator system permitted bedside performance of procedures with enhanced convenience and optimal medical management. Successful plasma exchange was associated with (1) sustained increases in the mean platelet count at 24, 48, and 72 hours that were 2.2, 3.6, and 4.5 times the preexchange platelet counts and (2) a decreasing trend in lactic dehydrogenase concentrations below 1000 IU/L within 48 hours of exchange plasmapheresis. The current series of patients supports our recommendation that a trial of plasma exchange(s) with fresh-frozen plasma be considered for treatment of the infrequent postpartum case of hellp syndrome that fails to abate within 72 hours of delivery and in which other evidence develops of an ongoing, widespread, and life-threatening thrombotic microangiopathy.- - - - - - - - - - ranking = 2keywords = delivery (Clic here for more details about this article) |
8/14. hellp syndrome.hellp syndrome is a triad of hemolysis, elevated liver enzymes and low platelet count during pregnancy and it is proposed to be a sign of severe preeclampsia. We present two mothers with this life-threatening condition. In the first case, the syndrome appeared after a twin delivery at 34 weeks of pregnancy. The mother required 10 days of intensive care with blood and thrombocyte transfusions. Both she and the infants survived. In the second case, the mother had all classic signs of severe preeclampsia at the 27 week of pregnancy. After 3 days' intensive care, a cesarean section was performed and both the mother and the child survived.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
9/14. Severe preeclampsia with persistent postpartum hemolysis and thrombocytopenia treated by plasmapheresis.A case of severe preeclampsia in which hemolysis and rapid platelet consumption persisted after delivery, but in which the blood urea nitrogen and serum glutamic oxaloacetic acid transaminase levels returned to normal is presented. Antiplatelet aggregating medications and exchange plasmapheresis with fresh frozen plasma were begun on the eighth postpartum day, but the hemolysis and rapid platelet consumption did not begin to improve until the 12th postpartum day. The use of plasmapheresis in highly selected cases of severe preeclampsia with hemolysis and thrombocytopenia that do not resolve after delivery is discussed.- - - - - - - - - - ranking = 2keywords = delivery (Clic here for more details about this article) |
10/14. Severe hypoglycemia associated with hellp syndrome.Presented is a case of the syndrome of hemolysis, elevated liver enzymes, and low platelet counts, in which severe maternal hypoglycemia occurred 8 hours after delivery. It is proposed that the hepatic pathologic features in this case were severe enough to interfere with glycogenolysis and glyconeogenesis.- - - - - - - - - - ranking = 1keywords = delivery (Clic here for more details about this article) |
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