SUCCESSFUL PREGNANCY IN A WOMAN WITH BETA-THALASSEMIA MAJOR: A CASE REPORT

Beta-thalassemia major is a transfusion-dependent hemoglobinopathy associated with chronic anemia, transfusion-related complications, and iron overload. Pregnancy in these patients is rare and requires multidisciplinary planning due to increased transfusion demands and temporary interruption of chelation therapy. Case description: A 29-year-old white female was diagnosed with beta-thalassemia major at 8 days of life and has since received regular red blood cell (RBC) transfusions. She underwent cholecystectomy in 2009 and splenectomy in 2015. In 2020, transfusion reactions required the use of washed RBCs. Iron overload was managed with different chelation regimens. In 2022, while on deferiprone, her serum ferritin was 403ng/mL, and liver T2* MRI showed no hepatic involvement. Chelation was discontinued in December 2022 for conception planning. Pregnancy was confirmed in April 2023, approximately 90 days later. Prenatal care was conducted at focusing on maintaining hemoglobin >10 g/dL, with transfusions every 15 days. At 6 weeks, she presented mild vaginal bleeding, successfully treated with progesterone. No chelation was performed during pregnancy. Delivery occurred at 38 weeks via elective cesarean section. Moderate intraoperative vaginal bleeding was controlled without transfusion. The newborn weighed 3,170 g, with Apgar scores of 9 and 9 at one and five minutes, respectively. She exclusively breastfed for 6 months. Four months postpartum, serum ferritin had increased to 4,463ng/mL. In September 2024, liver MRI demonstrated a hepatic iron concentration of 17.5 mg/g dry weight, confirming significant iron overload. Chelation therapy with deferiprone was resumed in June 2024. The patient remains on regular transfusions with stable hemoglobin levels and no major maternal or infant complications reported. Conclusion: This case highlights that a well-controlled iron burden before conception, strict hemoglobin maintenance during pregnancy, and multidisciplinary follow- up can result in a successful pregnancy and delivery in beta-thalassemia major. It also emphasizes the need for early postpartum reassessment of iron status and timely resumption of chelation therapy to prevent iron-related organ damage.