Critical Care Management of Systemic Lupus Erythematosus with Autoimmune Hemolytic Anemia and Thrombocytopenia in Pregnancy: A Case Report
DOI:
https://doi.org/10.59188/eduvest.v5i11.52433Keywords:
Autoimmunity, Systemic Lupus Erythematosus, Autoimmune Hemolytic Anemia, ThrombocytopeniaAbstract
Autoimmune diseases like Systemic Lupus Erythematosus (SLE) in pregnancy pose significant management challenges, particularly when complicated by severe hematological manifestations such as autoimmune hemolytic anemia (AIHA) and thrombocytopenia, which necessitate intensive care. This case report aims to describe the comprehensive intensive care management and outcomes of a pregnant patient with suspected SLE presenting with severe AIHA and thrombocytopenia. A qualitative case study design was employed. The research focused on a single, purposively selected 21-year-old primigravida at 30–31 weeks gestation. Data were collected from medical records and analyzed descriptively to document the patient's clinical presentation, diagnostic workup, multidisciplinary therapeutic interventions, and subsequent progress. The patient presented with severe anemia (Hb 5 g/dL) and thrombocytopenia (platelets 125,000/mm³). Management involved pregnancy termination, multiple packed red cell transfusions, high-dose corticosteroids (methylprednisolone), and mechanical ventilation. Following this aggressive regimen, the patient was successfully extubated on day 3 with hemodynamic stability and improved hematological parameters (Hb 9.6 g/dL). This case highlights that a multidisciplinary approach combining prompt delivery, immunosuppression, and intensive supportive care is crucial for favorable maternal outcomes. It underscores the importance of early recognition and aggressive treatment of autoimmune complications in pregnancy to prevent life-threatening consequences.
References
Anthony, B. (2020). Green Information System Integration For Environmental Performance In Organizations: An Extension Of Belief–Action–Outcome Framework And Natural Resource-Based View Theory. Benchmarking, 26(3), 1033–1062.
Dumas, G., Arabi, Y. M., Bartz, R., Ranzani, O., Scheibe, F., Darmon, M., & Helms, J. (2024). Diagnosis and management of autoimmune diseases in the ICU. Intensive Care Medicine, 50(1), 17–35.
Fizza Haider, S., Sloss, R., Jhanji, S., Nicholson, E., & Creagh‐Brown, B. (2023). Management of adult patients with haematological malignancies in critical care. Anaesthesia, 78(7), 874–883.
Guntupalli, K. K., Hall, N., Karnad, D. R., Bandi, V., & Belfort, M. (2015). Critical illness in pregnancy: part I: an approach to a pregnant patient in the ICU and common obstetric disorders. Chest, 148(4), 1093–1104.
Huang, S.-T., Yu, K.-H., Yuan, J.-W., Sun, Y.-B., Huang, Z.-Y., & Liu, L.-P. (2025). The impact of autoimmune diseases on delirium risk in critically ill patients: A propensity score matching multicenter analysis. (July).
Kumar Jr, M. J., Kotak, P. S., Acharya, S., Nelakuditi, M., & Parepalli, A. (2024). A comprehensive review of ocular manifestations in systemic diseases. Cureus, 16(7).
Leovic, M. P., Robbins, H. N., Starikov, R. S., & Foley, M. R. (2018). Multidisciplinary obstetric critical care delivery: The concept of the “virtual” intensive care unit. Seminars in Perinatology, 42(1), 3–8.
Misra, D. P. (2025). Clinical manifestations of rheumatoid arthritis, including comorbidities, complications, and long-term follow-up. Best Practice & Research Clinical Rheumatology, 39(1), 102020.
Murphy, K., & Weaver, C. (2022). Janeway’s Immunobiology (10th ed., pp. 77–128). W. W. Norton & Company, Inc.
Nusbaum, J. S., Mirza, I., Shum, J., Freilich, R. W., Cohen, R. E., Pillinger, M. H., Izmirly, P. M., & Buyon, J. P. (2020). Sex differences in systemic lupus erythematosus: Epidemiology, clinical considerations, and disease pathogenesis. Mayo Clinic Proceedings, 95(2), 384–394.
Pène, F., Russell, L., & Aubron, C. (2025). Thrombocytopenia in the intensive care unit: Diagnosis and management. Annals of Intensive Care, 15(1), 25.
Poli, S., Sciorio, F., Piacentini, G., Pietrobelli, A., Pecoraro, L., & Pieropan, S. (2024). Acute respiratory failure in autoimmune rheumatic diseases: A review. Journal of Clinical Medicine, 13(10), 3008.
Polok, K., Włudarczyk, A., & Szczeklik, W. (2019). Clinical profile of patients with systemic autoimmune diseases treated in the intensive care unit who developed diffuse alveolar haemorrhage: An observational retrospective cohort study, 96–101.
Rey, F., Andrea, S., Fernández, C., Laura, C., Cu, D., Sellanes, S. R., et al. (2021). Infections in systemic autoimmune diseases. 17(10), 582–587.
Sheth, M., Benedum, C. M., Celi, L. A., Mark, R. G., & Markuzon, N. (2019). The association between autoimmune disease and 30-day mortality among sepsis ICU patients: A cohort study, 1–11.
Singh, M., Fayaz, F. F. A., Wang, J., Wambua, S., Subramanian, A., Reynolds, J. A., Nirantharakumar, K., Crowe, F., & MuM-PreDiCT. (2024). Pregnancy complications and autoimmune diseases in women: Systematic review and meta-analysis. BMC Medicine, 22(1), 339.
Sulashvili, N., & Nimangre, R. R. (2025). Manifestation of some aspects of cardiovascular diseases, implications, pharmacotherapeutic strategies, effects, impacts and potential hazards in general. Junior Researchers, 3(1), 1–27.
Taraborelli, M., & Erkan, D. (2015). Pregnancy-related challenges in systemic autoimmune diseases. Journal of Infusion Nursing, 38(5), 360–368.
Yang, J., Chen, J., Zhang, M., Zhou, Q., & Yan, B. (2024). Prognostic impacts of repeated sepsis in intensive care unit on autoimmune disease patients: A retrospective cohort study, 1–11.
Yeung, H.-Y., & Dendrou, C. A. (2019). Pregnancy immunogenetics and genomics: Implications for pregnancy-related complications and autoimmune disease. Annual Review of Genomics and Human Genetics, 20(1), 73–97.
Zhu, J., Zhu, Q., Li, X., Shen, T., Shi, X., & Zhao, T. (2025). Systemic lupus erythematosus and male reproductive health: A systematic review and meta-analysis. Autoimmunity Reviews, 103742.
Zieleskiewicz, L., Chantry, A., Duclos, G., Bourgoin, A., Mignon, A., Deneux-Tharaux, C., & Leone, M. (2016). Intensive care and pregnancy: Epidemiology and general principles of management of obstetrics ICU patients during pregnancy. Anaesthesia Critical Care & Pain Medicine, 35, S51–S57.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Liliriawati Ananta Kahar
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
