CHALLENGES AND SOLUTIONS OF MAJOR THALASSEMIA COMPLICATED BY PULMONARY TUBERCULOSIS, SEVERE PREECLAMPSIA & HELLP SYNDROME: A RARE CASE REPORT
2Cardiology Division.Department of Internal Medicine., Dr. Hasan Sadikin General Hospital, University of Padjadjaran, Bandung
3Hemato Oncologi. Department of Internal Medicine, Dr. Hasan Sadikin General Hospital, University of Padjadjaran, Bandung
Problem Statement: Thalassemia pregnancy should be treated as a high-risk pregnancy. Given the fact that the consensus and studies on Thalassemia traits in pregnancy are still limited, this study aims to report a case of beta-Thalassemia Major complicated by pulmonary tuberculosis, severe preeclampsia, and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome which has not been previously reported in any literature as well as to discuss the challenges and solutions in managing this patient.
Methods: Case Report
Results: A 23years old primigravida was admitted to the hospital with beta-Thalassemia Major and co-existing pulmonary tuberculosis. She was anemic, stunted, and underweight. Hepatosplenomegaly was found. the lowest Hemoglobin level was 5g/dL, a hematocrit level of 22%, and her ferritin was 5816 μgram/L. Further examinations with electrocardiography and echocardiography showed normal results. Fetal ultrasound and Doppler impression were within normal limits. Fetal Non-Stress Test was routinely performed with reactive results. Her blood pressure suddenly increased at 39-40 weeks of gestation (180/110 mmHg) accompanied by HELLP syndrome. Termination of pregnancy was carried out by Caesarean Section. She gave birth to a female baby girl with a birth weight of 2330 grams. During pregnancy, the patient received antithrombotic in the form of Aspirin and Heparin in the post-partum period. Cardiac function and general condition monitoring were carried out together with the Department of Cardiology and Hemato Oncology.
Conclusion: Many considerations remain challenges to treating Thalassemia in pregnancy. To optimize obstetric management, insights into the pre-existing medical problems and anticipation of the potential complications related to Thalassemia syndromes along with multidisciplinary approaches hold pivotal roles in addressing this case.
Keywords: Beta-Thalassemia Major, Pregnancy, Pulmonary Tuberculosis, Preeclampsia, HELLP Syndrome
