Journal of Blood Disorders & Transfusion

Abstract

β-Thalassemia Intermedia with Immune Hemolysis during Pregnancy: A Report of Two Cases

Khawla M Belhoul, Ahmed M Khadhim, Hany E Dewedar and Fatheya Al-Khaja

Blood transfusion to treat β-Thalassemia Intermedia (BTI) during pregnancy carries a major risk of eliciting alloantibodies that cause hemolysis, which can progress to severe refractory hemolytic anemia. Moreover, autoimmune hemolytic anemia can develop either concurrently or shortly after alloimmunization induced by a blood transfusion. Here, the course and successful outcome of pregnancy is reported for two sisters with BTI who developed severe hemolysis following blood transfusion. Case 1 had heart failure at 31 weeks gestation necessitating a Caesarean section and splenectomy. She received rituximab and responded well. Case 2 was induced at 28 weeks of gestation due to non-reassuring fetal status. Neither case received blood transfusions early in childhood, which could have contributed to the severe alloimmune hemolysis observed when they received transfusions during pregnancy. However, both patients gave birth to viable offspring. The current case report is the first to describe both maternal and fetal outcome after an episode of immune hemolysis in pregnant BTI patients.