PB2400 COMBINED IRON CHELATION THERAPY IN WOMEN WITH TRANSFUSION DEPENDENT THALASSAEMIA DURING PREGNANCY: A SINGLE CENTRE OBSERVATIONAL STUDY
Authors: G. Wilfred, L. Wong, W. X. Wong, N. B. Zolkapli, F. Jacob
Journal: HemaSphere (2019)

Background: Advancement in the management of Transfusion Dependent Thalassaemia (TDT) have led to increased survival of patients into adulthood. Consequently, attention should be placed in managing pregnancy and its’ complication among women with thalassaemia. Pregnancy is characterized by dynamic changes, especially cardiovascular changes which may aggravate the underlying multiorgan damage of the pregnant mother and predispose to poor fetal growth and development. Chelation therapy is often a challenge due to the reported potential teratogenicity. Clinical data are limited regarding the use of iron chelation therapy during pregnancy especially if used in combination. Combination therapy should be restricted for cases where the potential benefit outweighs the potential fetal risk. Aims: In this case series, we described the used of combined iron chelation therapy among TDT patients who had successful pregnancy. Methods: We studied all women with TDT who became pregnant while on at least two iron chelation therapy (Desferioxamine, Deferiprone and/or Deferasirox) at Queen Elizabeth Hospital between January 2009 and January 2019. All of the cases included in the study consented to carry on with their pregnancy and majority decided to continue iron chelation therapy throughout pregnancy. Both maternal and fetal well-being were monitored closely. Data on types of chelation therapy, hemoglobin level, ferritin level and left ventricular function were obtained from the patient's medical record. Interview of cases and review of patient's records were performed to review toxicity from therapy and pregnancy outcome. Data was analyzed using descriptive statistics. Results: A total of four cases and seven pregnancies collected for our series. All of the cases were B-Thalassaemia Major and these were unplanned pregnancies. Mean age at pregnancy was 25 years old. Ferritin level prior conception ranges from 2500 to 10 800 ng/mL. None of the patient in our series received hormonal therapy prior to conception. Most of the patients had prior cardiac assessment and majority had severe cardiac iron overload based on MRI T2∗. The commonest combination used were Desferioxamine injection and oral Deferiprone. Two maternal complication observed at third trimester in our series which include impending cardiac failure and eclampsia. Fortunately, both patients delivered successfully albeit preterm. Three out of seven babies delivered at term and all cases were delivered via caesarean section. No fetal toxicity observed in all pregnancies and normal developmental milestone was reported. Summary/Conclusion: Combined iron chelation therapy in pregnancy was found to be safe in our case series. Discussion between healthcare provider and the patient is important before continuing chelation therapy during pregnancy and must be documented clearly.Decision to continue chelation therapy should be based on individual risk especially when the mother had preexisting organ damage prior pregnancy. Close monitoring is required to minimize potential hazard from therapy.