Improvement of maternal and fetal outcomes in women with sickle cell disease treated with early prophylactic erythrocytapheresis
Alice Vianello
Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
AV and EV have equally contributed to this work.
Search for more papers by this authorElisa Vencato
Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
AV and EV have equally contributed to this work.
Search for more papers by this authorMaurizio Cantini
Department of Transfusion Medicine, AOUI-Verona, Verona, Italy
Search for more papers by this authorGiovanni Zanconato
Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona and AOUI-Verona, Mother and Child Hospital, Verona, Italy
Search for more papers by this authorErminia Manfrin
Department of Diagnostic and Public Health, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
Search for more papers by this authorAlberto Zamo
Department of Diagnostic and Public Health, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
Search for more papers by this authorFrancesco Zorzi
Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
Search for more papers by this authorFilippo Mazzi
Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
Search for more papers by this authorNicola Martinelli
Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
Search for more papers by this authorElena Cavaliere
Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona and AOUI-Verona, Mother and Child Hospital, Verona, Italy
Search for more papers by this authorFrancesca Monari
Medicina II-CEMEF, University of Modena, Modena
Search for more papers by this authorDonatella Venturelli
Department of Transfusion Medicine, Azienda Ospedaliera Universitaria-Modena, University of Modena, Modena, Italy
Search for more papers by this authorFrancesca Ferrara
Department of Mother and Child, Azienda Ospedaliera Universitaria-Modena, University of Modena, Modena, Italy
Search for more papers by this authorOliviero Olivieri
Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
Search for more papers by this authorCorresponding Author
Lucia De Franceschi
Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
Address reprint requests to: Lucia De Franceschi, Department of Medicine, University of Verona-AOUI Verona, Policlinico GB Rossi, P.Le L. Scuro, 10, 37134 Verona, Italy; e-mail: [email protected].Search for more papers by this authorAlice Vianello
Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
AV and EV have equally contributed to this work.
Search for more papers by this authorElisa Vencato
Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
AV and EV have equally contributed to this work.
Search for more papers by this authorMaurizio Cantini
Department of Transfusion Medicine, AOUI-Verona, Verona, Italy
Search for more papers by this authorGiovanni Zanconato
Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona and AOUI-Verona, Mother and Child Hospital, Verona, Italy
Search for more papers by this authorErminia Manfrin
Department of Diagnostic and Public Health, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
Search for more papers by this authorAlberto Zamo
Department of Diagnostic and Public Health, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
Search for more papers by this authorFrancesco Zorzi
Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
Search for more papers by this authorFilippo Mazzi
Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
Search for more papers by this authorNicola Martinelli
Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
Search for more papers by this authorElena Cavaliere
Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona and AOUI-Verona, Mother and Child Hospital, Verona, Italy
Search for more papers by this authorFrancesca Monari
Medicina II-CEMEF, University of Modena, Modena
Search for more papers by this authorDonatella Venturelli
Department of Transfusion Medicine, Azienda Ospedaliera Universitaria-Modena, University of Modena, Modena, Italy
Search for more papers by this authorFrancesca Ferrara
Department of Mother and Child, Azienda Ospedaliera Universitaria-Modena, University of Modena, Modena, Italy
Search for more papers by this authorOliviero Olivieri
Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
Search for more papers by this authorCorresponding Author
Lucia De Franceschi
Department of Medicine, University of Verona and AOUI-Verona, Policlinico GB Rossi, Verona, Italy
Address reprint requests to: Lucia De Franceschi, Department of Medicine, University of Verona-AOUI Verona, Policlinico GB Rossi, P.Le L. Scuro, 10, 37134 Verona, Italy; e-mail: [email protected].Search for more papers by this authorAbstract
BACKGROUND
The desire for pregnancy in sickle cell disease (SCD) women has become a true challenge for hematologists, requiring a multidisciplinary approach. Erythrocytapheresis (ECP) is an important therapeutic tool in SCD, but only limited data on starting time and the effects of ECP during pregnancy are available.
STUDY DESIGN AND METHODS
This is a double-center retrospective cross-sectional study on a total of 46 single pregnancies in SCD women from January 2008 to June 2017. ECP was started at 10.7 ± 5.2 weeks of gestation, and prophylactic enoxaparin (4,000 U daily) was introduced due to the reported high prevalence of thromboembolic events in pregnant SCD women.
RESULTS
The alloimmunization ratio was 2.1 per 1,000 and the alloimmunization rate was 5.6%. In early ECP-treated SCD women, no severe vaso-occlusive crisis, sepsis or severe infection, or preeclampsia or eclampsia were observed. We found normal umbilical arterial impedance during pregnancy, suggesting an optimal uteroplacental function in early ECP–treated SCD women. This was also supported by the improvement in newborn birthweights compared to previous studies. In our cohort, three SCD women were started later on ECP (20-25 weeks), and gestation ended with late fetal loss. Placenta pathology documented SCD-related damage and erythroblasts in placental vessels, indicating fetal hypoxia.
CONCLUSIONS
Collectively, our data generate a rationale to support a larger clinical trial of early ECP program in SCD pregnancy.
CONFLICT OF INTEREST
The authors have disclosed no conflicts of interest.
Supporting Information
Additional Supporting Information may be found in the online version of this article at the publisher's website:
| Filename | Description |
|---|---|
| trf14767-sup-0001-suppinfo.docx15.4 KB | Table S1. Patient alloimmunization profile before, during, and after pregnancy |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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