Pregnancy complicated with agranulocytosis

Area of Science:

• Reproductive Medicine
• Hematology
• Immunology

Background:

• Pregnancy involves significant physiological changes, including leukocytosis, primarily due to increased neutrophils.
• Agranulocytosis during pregnancy is uncommon, often linked to pre-existing conditions or external factors like medications.
• Gestation-induced agranulocytosis, unrelated to known causes, is exceptionally rare, with limited case reports.

Observation:

• A 25-year-old primigravida at 38 weeks gestation presented with agranulocytosis and intermittent fever in the third trimester.
• Neutrophil granulocyte count was critically low (0.17 × 10^9/L) with normal red blood cell and megalokaryocyte levels on bone marrow biopsy.
• Initial investigations revealed positive antinuclear antibodies (1:40 dilution), but anti-dsDNA, antiphospholipid, and neutrophil granulocyte antibodies were negative.

Findings:

• Empirical treatment for pneumonia and various therapies including granulocyte colony-stimulating factor, immunoglobulins, glucocorticoids, antibiotics, and antifungals failed to improve the patient's condition.
• Resolution of agranulocytosis and fever occurred within 24 hours post-cesarean section.
• One-year follow-up confirmed the health of both mother and baby.

Implications:

• Agranulocytosis in pregnancy may be associated with pregnancy-related immunosuppression and immunoregulatory changes.
• Termination of pregnancy via cesarean section can be an effective treatment for refractory agranulocytosis complicating pregnancy.
• Further research is warranted to elucidate the mechanisms and confirm the efficacy of pregnancy termination for this rare condition.