Dermoid Cysts and Refractory Warm Autoimmune Hemolytic Anemia in Pregnancy

Autoimmune hemolytic anemia (AIHA) is a rare disorder during pregnancy. The management of AIHA in pregnancy is not well established and remains challenging. A 30- year-old woman presented with severe AIHA at 10 weeks of gestation. Bilateral adnexal cysts were identified on pelvic ultrasound. She received prednisone and intravenous immunoglobulin without any improvement. She developed preeclampsia at 26 weeks of gestation and delivered at 29 weeks. She received rituximab postpartum and showed no signs of improvement. Five months later, she developed abdominal pain. Computed tomographyof the abdomen and pelvis revealed cholelithiasis, splenomegaly, and bilateral adnexal cystic masses. The removal of bilateral ovarian dermoid cysts successfully resolved the AIHA. It is important to recognize that dermoid cysts can potentially lead to AIHA during pregnancy. To reduce health risks for the mother and fetus, it may be necessary to promptly remove these cysts through surgery instead of resorting to unnecessary immunosuppressive treatments.