Peripartum diagnosis of paroxysmal nocturnal haemoglobinuria: A case report

Paroxysmal nocturnal haemoglobinuria is a rare acquired haemopoietic disorder. The fertily rate of affected patients is low, however we report a patient who was unusually diagnosed in the peripartum period. A 29 year-old white nulliparous woman, at 34 weeks' gestation, was found to have thrombocitopenia and megaloblastic anaemia during a rise of blood pressure. Because of a progression of the anaemia and an increase of the indirect bilirubin, a caesarean section was performed with good fetal outcome. The diagnosis of paroxysmal nocturnal haemoglobinuria was performed 6 days after surgery and the patient was discharged 10 days later. Unfortunately, 24, and 45 days later, the patient was hospitalized again because of two episodes of cerebral thrombrosis, nevertheless without longterm neurologic consequences. In conclusion the diagnosis of paroxysmal nocturnal haemoglobinuria must be considered in a hypertensive pregnant patient with thrombocitopenia, anaemia and haemoglobinuria. During the puerperal period, antibiotic and oral anticoagulant therapies must be given.