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Mesalazine as a cause of fetal anemia and hydrops fetalis: A case report.

Abstract Mesalazine and its prodrug sulfasalazine are both used for inflammatory bowel disease. Sulfasalazine has been associated with hematological side-effects such as aplastic and hemolytic anemia in patients, but also in fetuses after intrauterine exposure. To our knowledge, we describe the first case of a fetus with severe anemia, and subsequent hydrops, where this drug was found at concentrations in the fetus corresponding to those in the mother and most likely responsible for the fetal condition.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29390381
OWN - NLM
STAT- MEDLINE
DCOM- 20180212
LR  - 20180212
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 50
DP  - 2017 Dec
TI  - Mesalazine as a cause of fetal anemia and hydrops fetalis: A case report.
PG  - e9277
LID - 10.1097/MD.0000000000009277 [doi]
AB  - RATIONALE: Mesalazine and its prodrug sulfasalazine are both used for
      inflammatory bowel disease. Sulfasalazine has been associated with hematological 
      side-effects such as aplastic and hemolytic anemia in patients, but also in
      fetuses after intrauterine exposure. To our knowledge, we describe the first case
      of a fetus with severe anemia, and subsequent hydrops, where this drug was found 
      at concentrations in the fetus corresponding to those in the mother and most
      likely responsible for the fetal condition. PATIENT CONCERNS: A uniparous woman
      was referred at 31 weeks of gestation due to a hydropic fetus with massive
      ascites and cardiomegaly. DIAGNOSES: The patient had Crohn's disease and was thus
      treated with 4 g mesalazine daily. The fetus had severe anemia with an initial
      hemoglobin level of 51 g/L. INTERVENTIONS: The maternal medication was
      discontinued and four intrauterine erythrocyte transfusions were given during
      three weeks. Plasma samples were drawn from mother and fetus during cordocentesis
      for later analysis of mesalazine. OUTCOMES: A healthy baby was born after 37 full
      weeks of gestation. Plasma levels of mesalazine were non-conspicuous in neither
      mother nor fetus. The mesalazine half-life in the fetus (37 h) was half that of
      the mother (80 h), both considerably longer than previously reported (about 19
      h). LESSONS: A causal relationship must be suspected between the fetal anemia and
      the maternal use of mesalazine. This fetal side-effect should be considered in
      pregnant women on mesalazine (and its prodrug sulfasalazine).
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Ek, Sverker
AU  - Ek S
AD  - Department of Obstetrics and Gynecology, Center of Fetal Medicine, Karolinska
      University Hospital.
FAU - Rosenborg, Staffan
AU  - Rosenborg S
AD  - Clinical Pharmacology, Karolinska University Laboratory and Division of Clinical 
      Pharmacology, Department of Laboratory Medicine, Karolinska Institutet,
      Stockholm, Sweden.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 4Q81I59GXC (Mesalamine)
SB  - AIM
SB  - IM
MH  - Anemia/*chemically induced/therapy
MH  - Anti-Inflammatory Agents, Non-Steroidal/*adverse effects
MH  - Erythrocyte Transfusion
MH  - Female
MH  - Fetal Diseases/*chemically induced/therapy
MH  - Humans
MH  - Hydrops Fetalis/*chemically induced/therapy
MH  - Mesalamine/*adverse effects
MH  - Pregnancy
MH  - Pregnancy Outcome
EDAT- 2018/02/03 06:00
MHDA- 2018/02/13 06:00
CRDT- 2018/02/03 06:00
PHST- 2018/02/03 06:00 [entrez]
PHST- 2018/02/03 06:00 [pubmed]
PHST- 2018/02/13 06:00 [medline]
AID - 10.1097/MD.0000000000009277 [doi]
AID - 00005792-201712150-00131 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Dec;96(50):e9277. doi: 10.1097/MD.0000000000009277.