Ž .International Journal of Gynecology & Obstetrics 69 2000 51]52

Brief communication

Filaria associated hemolysis in pregnancy

S. Basua,U, M. Wanchoob, A. Aggarwala, S. Malhotrab

aDepartment of Hematology and Transfusion Medicine, Chandigarh, IndiabDepartment of Gynecology and Obstetrics, Chandigarh, India

Received 8 November 1999; accepted 3 December 1999

Keywords: Pregnancy; Microfilaria; Hemolysis

Filariasis is a major public health problem inIndia and is endemic in most of its coastal states.The spectrum of clinical manifestations of lym-phatic filariasis ranges from asymptomatic micro-filaremia to symptomatic disease. Also many in-fected individuals with or without symptoms donot have microfilaremia and a definite diagnosis

w xin such patients can be difficult 1 . However, thehematological manifestations of lymphatic filari-

w xasis are generally limited to eosinophilia 2 . Wedescribe here a leucoerythroblastic blood picturein a case of bancroftian filariasis.

A 22-year-old primigravida with 38 weeks ges-tation presented with marked pallor. There wasno hepatosplenomegaly or lymphadenopathy. Shewas afebrile. Hemogram revealed hemoglobin of7.2 grdl, leucocytosis with a total count of16 200rcmm and reduced platelet countŽ .48 000rcmm . Blood film examination showed

U Corresponding author. a 1151-B, Sector-32B, Chandigarh,Pin 160047, India. Tel.: q91-172-665-253; fax: q91-172-609-360.

Ž .E-mail address: gmcchd@chl.dot.net.in S. Basu

moderate anisopoikilocytosis with macrocytes,hypochromic microcytes, fragmented cells andmild polychromasia, with numerous nucleated red

Ž .cells nRBCs38r100 WBC . The differentialleukocyte count showed neutrophils 39%, lym-phocytes 47%, eosinophils 10% and myelocytesand metamyelocytes 2% each. In additionsheathed microfilariae were seen singly, con-forming to the morphology of Wuchereria ban-crofti. The reticulocyte count was 4.2%.

Eosinophilia is the most common hematologicmanifestation of filarial disease. On reviewingliterature we found that dimorphic anemia andpancytopenia, although uncommon, are the other

w xhematologic manifestations of filarial disease 1 .It is also known that in endemic areas, a propor-tion of the population, although exposed to infec-tive larvae, do not show any hematologic alter-

w xations 2 . There are several reports of bone mar-w xrow involvement by microfilaria 1,3 . Shenoi et al.

have described three cases of pancytopenia withmicrofilaria in bone marrow. In seven cases ofanemia, Pradhan et al. have documented thepresence of microfilariae of W. bancrofti in bone

0020-7292r00r$20.00 Q 2000 International Federation of Gynecology and Obstetrics.Ž .PII: S 0 0 2 0 - 7 2 9 2 9 9 0 0 2 3 1 - 3

( )S. Basu et al. r International Journal of Gynecology & Obstetrics 69 2000 51]5252

marrow smears. All the patients were asympto-matic for filariasis.

The index case showed a thrombocytopeniawith a leucoerythroblastic picture. Leucoerythrob-lastic blood picture is an unusual finding and hasnot been described earlier in filarial disease. Theblood film morphology and raised reticulocytecount all indicate a hemolytic anemia, possiblydue to microfilaria. The plasma hemoglobin was

Ž .also raised 72 mgrl . The present case is the firstreport of hemolytic anemia in filarial disease.Intravascular hemolysis with circulating nucleatedred cells has been reported earlier in filarial in-

w xfection in animal studies only 4 . Here the au-thors have implicated dyshemopoiesis as one ofthe pathogenetic factors. In the present case, theleucoerythroblastic blood picture and hemolyasisis induced by filarial infection. Pregnancy couldalso be instrumental as alterations in the immuneresponse are known during this period.

The patient had an uneventful normal deliveryat 38 weeks of gestation. A repeat hemogramperformed after delivery showed similar findingswith few microfilariae in the blood film. In view ofthe thrombocytopenia, a marrow aspiration was

performed to look for microfilaria. The marrowaspirate showed a cellular marrow with erythroidhyperplasia but no microfilaria was seen. The

Žpatient was put on antifilarial therapy diethyl.carbamazine and discharged. After 6 weeks when

she revisited the hospital, her hemogram revealedŽthat blood counts were within normal limits Hb

12.5 grdl leucocytes 10 800rcmm and platelets.1.8=105rcmm several blood films examined

showed no microfilaria.To the best of our knowledge this is the first

report of filaria-induced hemolysis in pregnancy.

References

w x1 Shenoi U, Pai RR, Pai U, Nandi GK, Adhikari P. Micro-filariae in bone marrow aspiration smears. Acta Cytol1998;42:815]817.

w x2 Manson-Bahr PEC, Bell DR. Manson’s tropical diseases.London Bailliere Tindall, 1957:353]368.

w x3 Pradhan S, Lahiri VL, Elhence BR, Singh KN. Microfi-laria of Wuchereria bancrofti in bone marrow smear. Am JTrop Med Hyg 1976;25:199]200.

w x4 Ziegler C, Kaufer-Weiss I, Zahner H. On the pathogene-sis of anemia and leukopenia in filarial infection ofMastomys natalensis. Zentralbl Veterinaermed B 1991;38:123]134.