Doctors from two capital hospitals saved a 17-year-old mother with acute lymphoblastic leukemia and her baby

Thanks to the excellent collaboration between the medical teams of two capital hospitals – Tsaritsa Yoanna University Hospital (ISUL) and Maichin Dom Specialized Hospital for Active Treatment in Obstetrics and Gynecology – two lives were saved in the days following Easter: a 17-year-old pregnant woman with acute lymphoblastic leukemia and her newborn baby, ISUL reports.

On the first day of Easter, a 17-year-old pregnant patient in her 35th gestational week was admitted to the Clinic of Pediatric Clinical Hematology and Oncology at Tsaritsa Yoanna University Hospital (ISUL), subsequently diagnosed with hyperleukocytic acute lymphoblastic leukemia. Acute lymphoblastic leukemia is a malignant blood disease where immature white blood cells (lymphoblasts) accumulate in the bone marrow, unable to perform their normal protective function. In the so-called “hyperleukocytic” form, the number of these cells in the blood is particularly high, leading to severe suppression of normal blood clotting. This results in severe anemia, low platelet counts (associated with a risk of hemorrhage), and immune deficiency.

This condition is extremely high-risk for both the mother and the baby, especially during pregnancy when the body is under additional physiological stress. The high number of immature leukemic cells in the blood and severe thrombocytopenia significantly increase the risk of serious complications during childbirth, including difficult-to-control bleeding and infections.

The girl was referred to Tsaritsa Yoanna University Hospital (ISUL) by her GP following a blood test, which is mandatory at the beginning of the ninth month. Prior to this, she had shown no signs of the serious illness.

“In acute lymphoblastic leukemia, the disease develops very rapidly, literally within 2-3 weeks,” explains Assoc. Prof. Boryana Avramova, MD, Head of the Clinic of Pediatric Oncohematology at ISUL.

Doctors from Tsaritsa Yoanna University Hospital (ISUL) immediately contacted their colleagues at Maichin Dom to decide together how to proceed in this complex situation.

“Acute lymphoblastic leukemia, combined with pregnancy and all the resulting diagnostic and treatment difficulties, as well as the need to protect the fetus and prepare the girl for a rapid and minimally stressful delivery, presented the medical teams from both hospitals with a major challenge to our professional skills and determination,” said Assoc. Prof. Avramova.

A decision was made for the expectant mother to remain for treatment at Tsaritsa Yoanna University Hospital (ISUL), being transported daily by ambulance to the Clinic of Pathological Pregnancy at Maichin Dom to monitor the vital signs of the fetus. Meanwhile, the mother was prescribed a therapy gentle on both her and the baby, aimed at stabilizing her condition as much as possible and preparing her for the upcoming birth.

Due to critically low platelet levels and the high risk of heavy bleeding, multiple infusions of platelet concentrate were administered preoperatively at Maichin Dom. Following a multidisciplinary team discussion, it was decided to perform a Cesarean section delivery by obstetrician-gynecologists Dr. Veselin Dyavolov, Dr. Ibryam Ibryam, and Dr. Stefan Mladenov, with the participation of anesthesiologists Assoc. Prof. Emil Karzhin and Dr. Georgi Penev. Representing the Clinic of Pediatric Oncohematology at ISUL during the intervention were Assoc. Prof. Maya Yordanova and Dr. Nadezhda Yurukova. Care for the newborn was taken over by neonatologists Dr. Stanislava Hitrova, Head of the Intensive Care Unit at the Clinic of Neonatology, and Assoc. Prof. Liliya Vakrilova, Head of the Clinic of Neonatology.

“In this complex case, due to the hematological disease and certain anatomical features of the patient, we chose to apply general anesthesia instead of spinal, combined with fiber-optic intubation to minimize trauma, ensure precise control, and avoid additional risk of hemorrhage due to severe thrombocytopenia. This requires a particularly high level of preparation and experience from the anesthesiology team,” explained Assoc. Prof. Emil Karzhin, Head of the Clinic of Anesthesiology and Intensive Care at Maichin Dom.

A healthy baby boy was born, weighing 2,690 g and measuring 47 cm. Due to delayed adaptation, the newborn was admitted to the Intensive Care Unit of the Clinic of Neonatology, where he received oxygen therapy, intravenous nutrition, and a course of antibiotics. Following tests on the baby’s umbilical cord blood, no leukemic cells were found.

Currently, both the mother and the baby are in stable general condition. The child remains under the careful care of neonatologists at Maichin Dom, while the mother has been moved to the Clinic of Pediatric Clinical Hematology and Oncology at Tsaritsa Yoanna University Hospital (ISUL), where she continues treatment for her hematological disease.

The case represents an extremely rare and complex clinical situation requiring coordinated action and high expertise, the medical facility noted.