# Pregnancy in May–Hegglin Anomaly: Diagnostic Challenges and Management Considerations

## TL;DR

This paper discusses the challenges of diagnosing and managing May–Hegglin anomaly during pregnancy, emphasizing the need for a multidisciplinary approach to ensure safe outcomes for both mother and baby.

## Contribution

The paper presents a rare case of May–Hegglin anomaly in pregnancy and outlines specific diagnostic and management considerations.

## Key findings

- A 33-year-old pregnant woman was diagnosed with May–Hegglin anomaly after presenting with thrombocytopenia.
- Accurate diagnosis required genetic testing and blood smear analysis to distinguish MHA from immune thrombocytopenia.
- A multidisciplinary approach improved maternal and neonatal outcomes during pregnancy and cesarean delivery.

## Abstract

Introduction: May–Hegglin anomaly (MHA) is a rare autosomal dominant genetic disorder caused by mutations in the MYH9 gene, leading to the presence of Döhle-like inclusions in neutrophils, macrothrombocytes, and thrombocytopenia. This report presents a unique case of a 33-year-old pregnant woman diagnosed with MHA and discusses the diagnostic challenges and management strategies.

Case Presentation: A 33-year-old pregnant woman, 17 weeks into her pregnancy, presented with a history of persistent thrombocytopenia. She had previously been diagnosed with immune thrombocytopenia (ITP) and treated with steroids, intravenous immunoglobulin (IVIG), and thrombopoietin receptor agonists (TPO-RA). Her platelet counts had been between 35,000 and 50,000/μL. Upon referral to the hematology clinic, her platelet count was critically low at 15,000/μL, but the mean platelet volume (MPV) remained within normal limits. Despite her low platelet count, her coagulation profile was normal, and physical examination showed no pathological findings.

Diagnostic Assessment: The patient's blood smear revealed giant platelets and Döhle-like inclusions in the granulocytes. Genetic testing confirmed a heterozygous mutation in the MYH9 gene, leading to the diagnosis of MHA.

Therapeutic Intervention: Due to the risks associated with thrombocytopenia in pregnancy, her prenatal care included routine platelet monitoring and a normal bleeding time assessment. The patient underwent a cesarean delivery under general anesthesia, which resulted in the birth of a healthy baby boy.

Conclusion: The case highlights the importance of accurate diagnosis and careful monitoring in managing pregnancy in patients with MHA. A multidisciplinary approach involving obstetricians and hematologists is crucial for optimizing maternal and neonatal outcomes.