PREGNANCY WITH POLYCYTHEMIA VERA - AN OBSTETRIC CHALLENGE

Abstract

Polycythemia vera (PV) is a rare chronic myeloproliferative disorder of the haematopoietic stem cell type characterized by increased erythrocyte production. The disease is associated to a high risk of clinical complications - arterial and venous thrombosis, especially in pregnancy, bleeding, possible evolution to myelofibrosis and acute myeloid leukemia. We present the case of a 28-years-old patient, whose diagnosis was made 2 years before pregnancy (positive for mutation JAK2 V617F, bcr-abl negative, MPL, CALR negative). She was regularly monitored at the Hematology Clinic, had therapeutic venipunctures performed and anticoagulant therapy was prescribed. Pregnancy was regularly followed, with proper fetal growth and development, regular screening for fetal abnormalities, under anticoagulant therapy and under the supervision of a hematologist. At 34 weeks gestation, due to bleeding and pain, she was hospitalized in the Peripartal Intensive Care Department suspected of placental abruption. A caesarean section was performed immediately, a premature fetus was delivered in relatively good condition, and during the operation abruption of 1/3 of the placenta was found. The operative and postoperative periods were stable, the patient received replacement therapy and was discharged from the hospital on the 5th postoperative day in good general condition. The newborn was stabilized and discharged in good general condition after 3 weeks of stay at the Neonatal Intensive Care Department. Conclusion: Pregnancy in patients with this disease carries serious risks to the life and health of both mother and fetus, which requires special attention during pregnancy in order to reduce antenatal and postnatal morbidity.