[Therapeutic problems during pregnancy and delivery in two women with aplastic anemia]

We have observed two cases of aplastic anaemia diagnosed during the second trimester of pregnancy. In both patients a cesarean section was performed (in 32 and 37 week of gestation). During the course of pregnancy the patients received transfusions of erythrocytes and platelets. In one case high doses of methylprednisolone were administered. The same patient was given immunoglobulins IV prior to the delivery and the number of platelets increased to 100 x 10(9)/L. One baby had respiratory distress syndrome and died 3 months after birth. The second baby is 9 months old now and is in good health. Haematological improvement did not occur post partum and immunosuppressive treatment with antithymocyte globulin and cyclosporine was performed in both patients. Despite of that remissions did not occur and one patient died 7 months after delivery. The second patient still has haematological problems and is red cell and platelet transfusion dependent. We discuss the pathogenetic aspects of aplastic anaemia occurring during pregnancy, as well as the therapeutic problems before and after delivery.