Chronic Myeloid Leukaemia in Pregnancy; a case report of Anaesthetic Management.

Abstract

Chronic Myeloid Leukaemia (CML) is a myeloproliferative disorder marked by the Philadelphia (Ph) chromosome, a genetic mutation present in about 95% of cases. This mutation leads to uncontrolled proliferation of granulocytes and often progresses through chronic, accelerated, and blast phases. CML is uncommon, with an incidence of 1–2 cases per 100,000 people annually, and is rare in pregnancy, occurring in approximately 1 in 75,000 pregnancies. However, when CML does coincide with pregnancy, it presents complex challenges due to the impact on feto-maternal health.

The standard treatment for CML involves tyrosine kinase inhibitors (TKIs), which target the BCR-ABL1 protein. Due to the teratogenic risks associated with TKIs, alternative treatments such as hydroxyurea or interferon-alpha are often preferred in pregnancy, though these also carry risks like intrauterine growth restriction (IUGR). Leukapheresis is another option to manage high white blood cell counts, especially in the first trimester when medication options are limited.

Anaesthetic management for caesarean delivery in CML patients requires careful planning, as both regional and general anaesthesia have potential risks, including bleeding and increased likelihood of postpartum haemorrhage. A multidisciplinary approach involving haematology, obstetrics, and anaesthesia is essential to optimise outcomes.

This case report describes the anaesthetic and clinical management of a pregnant patient with CML undergoing emergency caesarean section, emphasising individualised care and interdisciplinary coordination.