Pregnancy and Idiopathic Autoimmune Haemolytic Anaemia: A Prospective Study during 6 Months Gestation and 3 Months <i>Post‐Partum</i>

Abstract

S ummary . A 31‐yr‐old woman with a 12 yr history of relapsing idiopathic autoimmune haemolytic anaemia was studied prospectively during her first pregnancy. Her serum contained a warm incomplete autoantibody as well as an elevated cold agglutinin; her red blood cells were strongly coated with IgG and complement (chiefly α2D). Haemolysis was active throughout pregnancy, accelerating from the 34th to 40th week, with developing thrombocytopenia. Amniocentesis in the 8th and 9th months suggested minimal foetal haemolysis. The maternal haemolytic process went into complete clinical remission following delivery of a healthy appearing infant whose red cells were coated with IgG. The infant developed mild hyperbilirubinaemia within 48 hr and experienced a fall in haemoglobin to 50% of the cord level by the 8th week. Abnormalities of maternal and infant C4 levels were observed. Review of 19 reported instances of presumed autoimmune haemolysis during pregnancy revealed life‐threatening anaemia in nearly 50% of mothers, with four still‐births, one neonatal death, and three seriously affected infants. A programme for prospective management of this serious clinical problem is discussed.