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Splenectomy for hairy cell leukemia in pregnancy
G M Stiles1, L M Stanco, A Saven
1Department of Surgery, Sharp Memorial Hospital, San Diego 92123, USA.
Objective:
Hairy cell leukemia is a rare hematologic malignant disease characterized by pancytopenia and splenomegaly. Its occurrence during pregnancy limits treatment with standard chemotherapeutic agents. A woman was found to have hairy cell leukemia and massive splenomegaly late in the second trimester. A review of the literature did not provide a carefully formulated treatment plan. It was believed that splenectomy (the historic therapy for hairy cell leukemia) would likely result in improved hematologic values and allow the pregnancy to progress.
Study Design:
Case report with literature review.
Results:
Preoperative laboratory studies revealed platelet count 65,000/mm3, hematocrit 28.6%, white blood cell count 4000/mm3, and hairy cell index 0.06 to 0.07. At 24 weeks' gestation, the patient underwent splenectomy with resolution of thrombocytopenia and normal progression of pregnancy without complication. Repeat cesarean section at 38 weeks produced a 2875 gm healthy male infant with Apgar scores of 9 and 9.
Conclusion:
If antepartum management of hairy cell leukemia is warranted, splenectomy is a safe and effective treatment option during the second trimester.