Seeing a patient: 29-year-old wf with ET (?PV). Hx: 3 years ago, plt count 1 million No Tx per heme and no w/u Has had 2 miscarriages Wants to get PREGNANT No bleeding or thrombosis wbc high 12.4 hgb 15.5 (borderline high) plt 850 vw panel Normal (ordered bc high plt but no bleed) ferritin 60 crp nl esr nl jak 2 pos LAP nl epo LOW 2 u/s splenomegaly bmbx: incr megas c/w ET bcr abl neg.  chromo pending (just done 48 hrs ago) no incr blasts or fibrosis

Burton F. Alexander, III MD
Virginia Oncology Associates

We'd like her on low-dose ASA during pregnancy, the intrapartum period and for six weeks postpartum (PP). If she has no other risk factors for thrombosis, I would reserve LMWH for the postpartum period only (i.e., enoxparin 40 mg qd for the first three weeks PP). We'd recommend fetal surveillance (detailed ultrasound in the second trimester, monthly ultrasounds in the third trimester, at least weekly testing in the last two months of pregnancy and delivery at 39 weeks). Although these women have an increased chance of poor pregnancy outcome, there is a good chance things will turn out well.

Andra James, MD, MPH
Director/Founder of the Women's Hemostasis and Thrombosis Clinic
Duke University Medical Center
Professor of Obstetrics & Gynecology
Duke University School of Medicine
Durham, NC