Hematologic data from the index patient.
(A) First pregnancy. At 6 weeks of pregnancy, white blood cell count is 5.5 × 103/μL with 3.4 granulocytes, 0.2 bands, 1.9 lymphocytes, and 0.1 eosinophils; platelets, 409 × 103/μL; and reticulocytes, 0.3%. The Hct increased late in the second trimester of this patient's pregnancy, and then decreased following a stillbirth at 30 weeks of gestation. Asterisks represent transfusions of packed RBCs. (B) Second pregnancy. The Hct increased in the middle of the second trimester and remained elevated during the 103 weeks (23 months) that the patient was breast-feeding her son. Data from the start of pregnancy through the first 44 weeks after birth are shown. Three additional Hct levels were obtained between week 80 (44 weeks after birth) and week 139 (103 weeks after birth) and were 36% to 38%. From week 86 to 103, the patient breastfed her son only once each day. The asterisks represent transfusions of packed RBCs. A third pregnancy followed a comparable course. The Hct was maintained at more than 27% with prednisone 20 to 40 mg daily, and a healthy daughter was born at 40 weeks. With blood loss at the time of the cesarean delivery, the Hct decreased to 18%, but increased to 27% to 30% over the next 3 weeks without transfusion. The Hct also transiently decreased when prednisone was discontinued at 7 months after birth, but spontaneously recovered and remained 30% to 35% for the 16 additional months that she breastfed her daughter one or more times each day.
