Through the Microscope: Anaemia in Pregnancy - Nutritional vs Aplasia

 Anaemia is a medical term understood by many to be a condition in which there is a deficiency of red blood cells in the body, and is generally characterised by a paleness of the skin and tiredness of the body. In pregnancy, anaemia is mainly associated with a lack of iron or folic acid or red blood cells.  However, in a recent study titled Pure Red Cell Aplasia of Pregnancy - A Potentially Fatal and Rare Entity conducted by MAHSA University’s Director of Research, Innovation and Postgraduate Studies in the Faculty of Medicine, Dr Srikumar Chakravarthi, with two of his peers, Dr Karthikesh Jaya Kumar of the Department of Pathology, KSR Institute of Dental Sciences and Research, Trichengode, Tamil Nadu, India, and Dr Barani Karikalan of the Department of Pathology, Perdana University - Royal College of Surgeons in Ireland, new insights into a rare case of anaemia in pregnant women known as Pure Red Cell Aplasia (PRCA) was presented and its need for an early diagnosis with correct treatment was concluded as a means to avoid fatality. 

Pure red cell aplasia (PRCA) refers to the failure of the bone marrow to function properly, leading to a disruption in the production of red blood cells which are necessary for carrying oxygen to the body.  When the body does not get sufficient oxygen, the result is anaemia - it is very important to distinguish between PRCA and aplastic anaemia.  Aplastic anaemia is a condition that occurs when the body stops producing enough new blood cells, while PRCA involves the bone marrow.  There have been very few cases of pure red cell aplasia (PRCA) reported during pregnancy. Along with its rareness PRCA is also and known to be potentially fatal if it is not diagnosed early. 

The research specifies that pregnant women with PRCA should not be given steroids, nor should the pregnancies be terminated.  Instead, PRCA during pregnancy should be managed according to individual symptoms until the birth of the baby, since recovery will occur naturally after delivery. Pure red cell aplasia comprises a range of disorders that result in the failure of the body to produce red blood cells.  This syndrome is defined by anaemia, an abnormal decrease in the number of new red blood cells, and a decrease in the producers of red blood cells.  Red cells are generally normal in size and occasionally abnormally large in size.  White cell counts and platelet counts are within the normal range.  The study also shows that pure red cell aplasia has been associated with drugs, viruses, immunological disorders, and malignancies of the thymus and lymphoid (organs necessary for the functioning of the immune system).  However, most PRCA are found to be idiopathic which have immunological causes.

Pure red cell aplasia in pregnancy is rare, and must be diagnosed since this type of anaemia does not respond to the usual treatment and can be potentially fatal if not treated appropriately.  Haemoglobin levels have to be carefully monitored throughout pregnancy and treated symptomatically.  Pure red cell aplasia in pregnant women is characterised by early onset of anaemia and spontaneous recovery after labour with recurrence seen in subsequent pregnancies.