Case Report of Transient Abnormal Myelopoiesis in Fetuses with Down Syndrome
Wirada Hansahiranwadee MD1, Chayada Tangshewinsirikul MD1, Panyu Panburana MD1
Affiliation : 1 Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Objective : To report ultrasound (cid:976)indings and the clinical course of transient abnormal myelopoiesis [TAM] in fetuses with Down
syndrome.
Case Report: Medical records of two cases of con(cid:976)irmed TAM in Down syndrome were retrospectively reviewed. The authors
reviewed prenatal ultrasonographic (cid:976)indings, fetal blood analysis, (cid:976)low cytometry, and the postnatal clinical course.
Results : Between May 2010 and September 2013, two cases of TAM associated with Down syndrome were con(cid:976)irmed. 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.
Keywords : Transient abnormal myelopoiesis, Down syndrome, Hydrops fetalis, Prenatal ultrasonography, Fetal anemia
