Aplastic Anemia in Pregnancy: A Case-Based Comprehensive Review of the Literature

Background and Aim: Aplastic anemia (AA) is a rare and life-threatening hematologic disorder characterized by pancytopenia and bone marrow failure. Paul Ehrlich was the first to describe aplastic anemia in 1888, having observed it during an autopsy of a young pregnant woman who tragically passed away following a sudden, severe illness.Its occurrence during pregnancy is exceedingly rare, posing significant risks and management challenges for both the mother and the fetus. Aplastic anemia during pregnancy is a rare condition, and the incidence of it is not well-established due to its rarity. In general, the incidence of aplastic anemia is estimated to be around 2 to 7 cases per million people per year in Western countries, while higher incidences have been reported in Asia, with up to 15 cases per million people per year and in Albania the incidence resulted in 1.35 per million inhabitants. In pregnancy, the occurrence of AA is even more rare and poses significant risks and management challenges for both the mother and the fetus.
Method: We present here a 23-years old patient diagnosed with Severe Aplastic Anemia during the second trimester of pregnancy and we performed a comprehensive literature review of the past 20 years papers published in English language identified through searches in PubMed, Medline, Embase, and the Cochrane Library, to provide an in-depth analysis of the current understanding of AA in pregnancy, encompassing its etiology, pathophysiology, diagnosis, treatment, and outcomes.
Results: The etiology of AA in pregnancy is often idiopathic, with potential causes including exposure to certain chemicals, radiation, medications, viral infections, and autoimmune or genetic factors. Although the exact mechanism of AA in pregnancy is not fully understood, it is hypothesized that pregnancy-associated immune modulation may play a role in the development or exacerbation of the disease.
Conclusion: Given the rarity and complexity of AA in pregnancy, there is a need for a comprehensive review of the literature to better understand the current state of knowledge and best practices in managing this challenging condition.