Management of pregnancy-induced autoimmune haemolytic anaemia with rituximab. A case report and narrative review

Autoimmune haemolytic anemia (AIHA) during pregnancy is rare and may lead to significant maternal and fetal complications. Corticosteroids are considered first-line therapy, but alternative treatments are required in refractory cases. We report the first reported case of documented recurrent pregnancy-related AIHA successfully managed with rituximab during pregnancy. A 26-year-old woman was diagnosed with AIHA at 23 weeks of gestation during her second pregnancy, having previously exhibited corticosteroid-resistant disease. Prednisolone (70 mg/day) was initiated, followed by a single 1-g dose of rituximab at 24 weeks. Haemolysis stabilized within two weeks, enabling steroid tapering. Fetal monitoring with serial middle cerebral artery peak systolic velocity Doppler remained normal throughout gestation. Labor was induced at 39 weeks due to recurrent maternal haemolysis, and a healthy newborn was delivered without evidence of anemia or immunosuppression. This case illustrates the potential role of rituximab in selected corticosteroid-resistant AIHA during pregnancy and underscores the importance of individualized, multidisciplinary management.