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CC BY-NC-ND 4.0 · AJP Rep 2021; 11(04): e137-e141
DOI: 10.1055/s-0041-1740561
Case Report

Conservative Management of Presumed Fetal Anemia Secondary to Maternal Chemotherapy for Acute Myeloid Leukemia

Christina M. Nowik 
1   Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
,
Alina S. Gerrie
2   Division of Hematology and Medical Oncology, University of British Columbia, BC Cancer Agency, Vancouver, British Columbia, Canada
,
Jonathan Wong
3   Division of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract

Acute myeloid leukemia occurs rarely during pregnancy. When it is diagnosed remote from term, treatment in the form of daunorubicin plus cytarabine induction with consolidative cytarabine is typically undertaken after the first trimester. There is little data to guide fetal monitoring, in particular, whether and how often middle cerebral artery peak systolic velocity (MCA PSV) should be measured to screen for fetal anemia. Cytarabine may be particularly myelosuppressive to the fetus, but information pertaining to the management of this complication is also lacking in published literature. To our knowledge, we present the first case of presumed severe fetal anemia related to in utero exposure to chemotherapy that was managed conservatively with close sonographic monitoring, including serial measurement of MCA PSV. This case suggests that in the absence of hydrops fetalis or other signs of fetal decompensation, expectant management with ultrasound twice weekly, including MCA PSV, is appropriate. Ultrasounds may be decreased to weekly when MCA PSV does not suggest fetal anemia. Screening for fetal anemia can provide helpful information to guide the timing of chemotherapy administration and delivery.

Key Points

  • Chemotherapy for acute myeloid leukemia can cause fetal anemia.

  • Fetal MCA PSV can be used to safely and effectively screen for fetal anemia.

  • Observation of fetal anemia due to chemotherapy is reasonable, in the absence of hydrops.

  • Monitoring of fetal MCA PSV can help guide timing of chemotherapy and delivery.

Keywords

leukemia - myeloid - acute pregnancy - ultrasonography - Doppler fetal monitoring


Publication History

Received: 09 July 2020

Accepted: 08 October 2021

Article published online:
15 December 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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