We report a 31-year-old woman with sickle beta thalassemia zero who presented at 21 weeks gestational age with multiple bilateral pulmonary emboli and no hemodynamic instability. Acquired antithrombin deficiency was suspected due to a refractory response to therapeutic anticoagulation with enoxaparin, unfractionated heparin, and fondaparinux, and a reduced antithrombin antigen level. At 26 4/7 weeks, she developed signs concerning for increased pulmonary clot burden. To avoid the use of alternative anticoagulants that may cross the placenta and impact the fetus, a planned cesarean delivery was performed without complication at 27 weeks gestation. Both mother and child experienced successful long-term outcomes.
From the *Department of Anesthesiology, Perioperative & Pain Medicine
†Division of Cardiothoracic Anesthesia, Icahn School of Medicine at Mount Sinai Hospital, New York, New York.
Accepted for publication September 17, 2018.
The authors declare no conflicts of interest.
Address correspondence to Ashley V. Wells, MD, Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mt Sinai Hospital, Box 1010, One Gustave L Levy Pl, New York, NY 10029. Address e-mail to Awells2245@gmail.com.