///2009 Abstract Details
2009 Abstract Details2019-08-03T15:55:31-05:00

CYCLIC NEUTROPENIA IN A PREGNANT PATIENT

Abstract Number: 231
Abstract Type: Case Report/Case Series

GERMAN MONSALVE ANESTHESIOLOGIST1 ; ERICA HOLGUIN ANESTHESIOLOGIST2; TATIANA GALLO ANESTHESIOLOGIST3; JUAN MANUEL CASTILLO ANESTHESIOLOGIST4; GONZALO ARANGO ANESTHESIOLOGIST5; MARIA VIRGINIA GONZALEZ ANESTHESIOLOGIST6

Cyclic neutropenia (CN) is a hematological disease characterized by periodic episodes of severe neutropenia. We present the case of a pregnant patient with CN, who did not show improvement of the symptoms during pregnancy.

CASE REPORT: A 25 year old primigravid with 39 weeks, prenatal care by high risk obstetrics and hematology and a diagnosis of CN since childhood presented in active labor. She had previous episodes of pulmonary tuberculosis, meningitis, A hepatitis, tonsillitis and skin infections, and several episodes of threat of abortion and premature labor. Leukocytopenia and neutropenia were present at admission. When a neutrophils nadir of 9% was reached, granulocyte colony-stimulating factor (G-CSF) 300 g OD for 3 days and prophylactic ampicillin-sulbactam and doxycycline were started. Epidural analgesia for labor and vaginal birth was placed; a birth canal and uterine cavity revision was required. Epidural catheter was withdrawn 6 hours after birth. Evolution was satisfactory.

The granulocytes profile before and after G-CSF is shown in table1.

DISCUSSION:CN is an autosomal dominant disease in which cyclic haemopoiesis produces recurrent and severe neutropenia, associated to infections caused by opportunistic agents. Neutrophil count can diminish to 200 cells/mm3 to 0.These episodes last from 3 to 6 days, every 21 to 28 days, (average 14-28 days). Patients are usually asymptomatic, but during episodes of severe neutropenia can present with fever, oral ulcers, gingivitis, stomatitis, and abdominal infections usually caused by Clostridium species.

There are few reports of CN and pregnancy; most suggesting an improvement during the second or third trimester, secondary to an increase in steroids hormones and/or the presence of G-CSF from the fetus and placenta. Frequent complications include preterm labour, intrauterine growth restriction, puerperal infection, pyelonephritis, and wound dehiscence and infection. During puerperium, strict control of infection must be done even prophylactic antibiotics are indicated for 4 -6 days.

The administration of G-CSF plays an important role in the prevention of infection during the periods of lowest counts of neutrophils; the factor stimulates proliferation and survival of neutrophil progenitors and promotes differentiation of them to mature cells. The effects of G-CSF in the fetus are not clear yet.

REFERENCE.

1. Spontaneous remission of cyclic neutropenia during pregnancy. J Reprod M 2001; 46:141-1



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