Case report of transient abnormal myelopoiesis in fetuses with down syndrome

Abstract

© 2018, Medical Association of Thailand. All rights reserved. Objective: To report ultrasound findings and the clinical course of transient abnormal myelopoiesis [TAM] in fetuses with Down syndrome. Case Report: Medical records of two cases of confirmed TAM in Down syndrome were retrospectively reviewed. The authors reviewed prenatal ultrasonographic findings, fetal blood analysis, flow cytometry, and the postnatal clinical course. Results: Between May 2010 and September 2013, two cases of TAM associated with Down syndrome were confirmed. Sonographic presentations of non-immune hydrops fetalis initially manifested late in the second trimester to the early third trimester, including fetal ascites, hepatomegaly, and cardiomegaly. Congenital infection was precluded. A complete blood count from cord blood in both cases showed abnormal leukocytosis with blast cells and fetal anemia. The platelet count showed thrombocytosis in one patient and thrombocytopenia in the other patient. Preterm birth was the only adverse obstetric outcome found in both cases. TAM spontaneously resolved after birth. Conclusion: Fetal TAM is a hematological condition causing non-immune hydrops fetalis in fetuses with Down syndrome. Liver failure and anemia-induced high-output heart failure could be the pathogenesis of hydrops.