July 21st, 2018

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Misinterpretation of Hematological Changes in Pregnancy and Postpartum Hemorrhage Due to Leukemia and Pregnancy: A Case Report
Authors:  Anca A. Simionescu, M.D., Ph.D., and Nicoleta Berbec, M.D., Ph.D.
BACKGROUND: Postpartum hemorrhage remains a major cause of maternal death worldwide. Hematological malignancy can be difficult to diagnose during pregnan-cy because of the physiological changes.

CASE: We present the case of a pregnant woman with postpartum hemorrhage due to a missed diagnosis of acute promyelocytic leukemia in pregnancy despite serial blood count tests and symptoms suggestive of hematological malignancies. No anemia or neutropenia was observed, and her white blood cell count with leukocytes was 4,000–8000/mm3. Thrombocytopenia 100,000–128,000/mm3 in the third trimester was thought to be pregnancy-related. The patient gave birth underwater in a level I private mater-nity ward and was transferred to Intensive Care 2 hours after delivery. The diagnosis of acute promyelocytic leukemia was made 1 month after delivery.

CONCLUSION: Blood abnormalities are difficult to diagnose during pregnancy, but it is very important to correctly interpret routine blood count tests in pregnancy.
Keywords:  acute promyelocytic leukemia; hematologic pregnancy complications; intensive care; maternal death; postpartum hemorrhage; pregnancy; pregnancy complications; pregnancy complications, hematological; promyelocytic leukemia; thrombocytopenia
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