Pure red cell aplasia (PRCA) may rarely be linked to pregnancy.


Criteria for the diagnosis:

(1) presence of pure red cell aplasia

(2) an association with pregnancy

(3) exclusion of alternative explanations

(3a) for pure red cell aplasia

(3b) for anemia


Features of pure red cell aplasia:

(1) profound chronic macrocytic or normochromic, normocytic anemia

(2) decreased or absent reticulocytes in the peripheral blood

(3) decreased or absent nucleated red blood cells in the bone marrow

(4) normal leukocyte count in the peripheral blood with a normal differential count

(5) normal number of myeloid precursors in the bone marrow

(6) normal platelet count

(7) normal number of megakaryocytes in the bone marrow

(8) absence of hemorrhage or hemolysis

(9) absence of extramedullary hematopoiesis


Association with pregnancy:

(1) onset during pregnancy

(2) remission after delivery

(3) past history during pregnancy (relapse on subsequent pregnancies)


A woman with a history of pure red cell aplasia associated with pregnancy may develop red cell aplasia following exposure ot medroxyprogesterone.


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