Sarita Agrawal¹, Arya J²*, Sarita Rajbhar³, Pushpawati Thakur¹ and Aakansha Sahu²

¹Professor, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Raipur, India
²Junior Resident, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Raipur, India
³Additional Professor, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Raipur, India

*Corresponding Author: Arya J, Junior Resident, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Raipur, India.

Received: April 29, 2025; Published: May 29, 2025

Abstract

This case report details the multidisciplinary management of a 23-year-old primigravida with rheumatoid arthritis (RA) who presented with severe, transfusion-refractory anemia of chronic disease (ACD) at 24 weeks of gestation. Despite receiving seven packed red blood cells (PRBCs) units over six months, her hemoglobin remained critically below 5 g/dL. Investigations revealed high serum ferritin and transferrin saturation, consistent with iron overload. On further history h/o rheumatoid arthritis managed with tofacitinib and a history of previous blood transfusion were elicited. While her RA markers were within normal limits, an elevated ESR (100 mm/hr) indicated ongoing inflammation. Hence the diagnosis of ACD was made. Treatment with high-dose corticosteroids (methylprednisolone followed by oral prednisolone) resulted in a significant improvement in hemoglobin levels (reaching 10 g/dL) without further transfusions. The patient delivered a late preterm male infant at 36+3 weeks of gestation. This case highlights the importance of considering ACD in the differential diagnosis of severe, transfusion-refractory anemia in pregnant women with autoimmune conditions, emphasizing the need for a multidisciplinary approach and the potential efficacy of corticosteroids in achieving hematologic recovery and favorable perinatal outcomes.

Keywords: Transfusion Refractory Anemia in Pregnancy; Anemia of Chronic Disease; High Risk Pregnancy; Multidisciplinary Management; Steroid Therapy

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Citation

Citation: Arya J., et al. “Multidisciplinary Rescue: Managing Transfusion Refractory Severe Anemia in Pregnancy with Underlying Rheumatoid Arthritis". Acta Scientific Clinical Case Reports 6.6 (2025): 25-29.

Copyright

Copyright: © 2025 Arya J., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.