Thalassemia and spinal cord compression in pregnancy

• Published in: Canadian Medical Association journal (CMAJ) Vol. 182; no. 17; p. E798
• Main Authors: Esfandbod, Mohsen, Malekpour, Mahdi
• Format: Journal Article
• Language: English
• Published: Canada CMA Impact Inc 23.11.2010; CMA Joule Inc; CMA Impact, Inc; Canadian Medical Association
• Subjects: beta-Thalassemia - diagnosis; beta-Thalassemia - etiology; beta-Thalassemia - pathology; Care and treatment; Cesarean section; Complications and side effects; Development and progression; Diagnosis; Female; Hematopoiesis, Extramedullary; Humans; Magnetic Resonance Imaging; Patient outcomes; Patients; Practice; Pregnancy; Pregnancy Complications - diagnosis; Pregnancy Complications - etiology; Pregnancy Complications - pathology; Pregnancy, Complications of; Risk factors; Spinal cord; Spinal cord compression; Spinal Cord Compression - diagnosis; Spinal Cord Compression - etiology; Spinal Cord Compression - pathology; Thalassemia; Treatment Outcome; Young Adult; Canada
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.091427

The patient was given dexamethasone for spinal cord syndrome and underwent emergency magnetic resonance imaging (MRI) of her spine. A posterior extradural mass, suggestive of an extramedullary hematopoietic centre, compressing the spinal cord was seen from levels T4 to T8 (Figure 1A). A presumptive diagnosis of extramedullary hematopoiesis was made. Because of the high risk of bleeding, a biopsy of the mass was not undertaken. An emergency cesarean delivery was performed under general anesthesia, resulting in the successful delivery of a healthy infant. The patient underwent radiotherapy and concomitant treatment with hydroxyurea for 14 days, along with hypertransfusion to reach a hemoglobin level of 150 g/L. Follow-up MRI after 30 days showed no sign of the mass (Figure 1B) and the patient could walk without difficulty. There were no major neurologic sequelae.