Pregnancy-induced aplastic anaemia with platelet refractoriness: clinical insights

Aplastic anaemia is a rare and potentially life-threatening condition that can worsen during pregnancy. Its management poses unique challenges due to risks of haemorrhage, infection and transfusion complications. We present a case of a second gravida woman in her 30s with progressive bicytopenia starting in the second trimester. Despite multiple transfusions, her platelet counts remained critically low due to suspected platelet refractoriness. Bone marrow biopsy confirmed aplastic anaemia. She was managed with supportive care and steroid pulse therapy, and delivery was planned at term. An emergency caesarean was performed for arrest of labour under general anaesthesia. The patient made a gradual recovery postnatally without requiring bone marrow transplantation. Her counts normalised by 3 months postpartum, supporting the diagnosis of pregnancy-induced reversible aplastic anaemia. This case highlights the importance of multidisciplinary management and the challenges of transfusion refractoriness in resource-limited settings.