Delivery management in a woman with thrombocytopenia of the May-Hegglin anomaly type

Epidural anesthesia for labor and delivery in a patient with May-Hegglin anomaly: a case report

We report a case of May-Hegglin anomaly (MHA) in a woman who had a successful labor and delivery under epidural anesthesia. MHA is an inherited thrombocytopenia easily misdiagnosed as idiopathic (immune) thrombocytopenic purpura (ITP). Early and appropriate diagnosis of MHA during pregnancy is essential for optimal maternal and neonatal delivery outcome. Additionally, it can avoid unnecessary diagnostic studies, such as bone marrow aspiration and biopsy, and even harmful therapies with corticosteroids, immunosuppressive agents, and splenectomy. Consequently, the most serious impacts of this disease are iatrogenic managements due to misdiagnosis. It seems that in patients with MHA, adequate clinical coagulation is far more dependent on adequate platelet function than any particular platelet count. The diagnosis of MHA may pose a challenge for clinicians managing pregnant women with thrombocytopenia.

Perinatal Management for a Pregnant Woman with an MYH9 Disorder

We diagnosed a primipara woman with an MYH9 disorder during her pregnancy. A peripheral blood smear with an immunofluorescence analysis is the established method of diagnosing MYH9 disorders. We provided genetic counseling, as required, which included apprising the woman of the inheritance pattern, the importance of a genetic analysis, and the potential delivery risks for the patient and her offspring. Given that the potential delivery risks are reportedly low, special perinatal management is not necessary for patients with an MYH9 disorder whose platelet count is above 5.0 × 10(4)/μL, except for rapid blood access.

First report of reproductive assistance in a woman affected by May-Hegglin anomaly

PURPOSE

To report the first case of fertility treatment in a patient with May-Hegglin anomaly, a rare hematological disorder inherited as an autosomal dominant trait.

METHOD

We present a case report of a 40-year-old nulliparous patient with May-Hegglin anomaly who underwent her first ICSI cycle with transfer of three fresh embryos.

RESULTS

Prophylactic platelet transfusion obtained by single-donor apheresis was performed 1 h before the oocyte pick up. No complications were reported. No pregnancy was obtained.

CONCLUSIONS

We report about the possibility to assist women affected by May-Hegglin anomaly requiring reproductive assistance. However, a multidisciplinary team composed of gynecologists and hematologists should follow such patients carefully, in order to carry out a complete clinical evaluation and to prevent the potential risks of bleeding. Clinicians must be vigilant in their presentation of risks, benefits, and alternatives.

Perioperative management of a patient with May-Hegglin anomaly requiring craniotomy

May-Hegglin anomaly (MHA) is a rare type of autosomal dominant platelet disorder associated with mutations in the gene encoding nonmuscle myosin heavy chain 9 (MYH9). It is characterized by the presence of large platelets, leukocyte inclusions, and thrombocytopenia. The bleeding tendency is usually mild, but severe hemorrhages have been reported. This is the first reported case of a patient with MHA who underwent craniotomy for intractable seizure disorder of temporal lobe origin. Patients who have thrombocytopenia have a higher likelihood of developing intraoperative or postoperative intracranial hematoma and bleeding complications. The patient was administered desmopressin (DDAVP) prior to the neurosurgical procedure and had no complications. With this approach, the use of platelet concentrates could be avoided. We discuss the role of DDAVP in MHA and related platelet disorders and review the current literature.