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Emergency Cesarean Section With Acute Promyelocytic Leukemia and Disseminated Intravascular Coagulation-A Case Report
Rachel M Smith-Steinert1, Benu Makkad2
1Assistant Program Director for the Nurse Anesthesia Program at the University of Cincinnati and serves as a CRNA Lead of Education Integration at the University of Cincinnati Medical Center, University of Cincinnati, College of Nursing, Cincinnati, Ohio.
This case report details a pregnant patient with acute promyelocytic leukemia (APML) requiring emergency cesarean delivery. Management involved careful consideration of bleeding risks and all-transretinoic acid (ATRA) therapy, highlighting a multidisciplinary approach for optimal outcomes.
Area of Science:
- Hematology
- Obstetrics
- Anesthesiology
Background:
- Acute promyelocytic leukemia (APML) during pregnancy presents a significant risk of mortality due to coagulopathy and bleeding.
- Prompt diagnosis and treatment are crucial for improving maternal survival in APML cases.
Observation:
- A 19-year-old pregnant female with new-onset APML required emergency cesarean delivery due to respiratory distress and suspected placental abruption.
- Antifibrinolytic use for postpartum hemorrhage was contraindicated due to concurrent all-transretinoic acid (ATRA) therapy for APML.
Findings:
- The case highlights the complexities of managing APML in pregnancy, particularly concerning anesthesia during emergent cesarean delivery.
- Effective management required a multidisciplinary team to balance APML treatment, ATRA therapy, and delivery timing.
Implications:
- This case provides valuable insights into the management of APML in pregnancy and associated anesthetic considerations.
- Successful outcomes underscore the importance of coordinated multidisciplinary care in high-risk obstetric cases involving hematological emergencies.
