Grand Rounds

Hereditary Spherocytosis with splenectomy in a Pregnant Woman - How to manage the immunizations?

Tsering Yangchen Dirkhipa1, Suhani Jain2, Meenakshi Dey3, Ira Shah3,1
1Department of Pediatric Infectious Diseases, B J Wadia Hospital for Children, Mumbai, India, 2Grant Medical College and Sir J J Group of Hospitals, Mumbai, India, 3Department of Pediatric Infectious Diseases, Nowrosjee Wadia Hospital for Children, Mumbai, India

Address for Correspondence: Dr Tsering Yangchen Dirkhipa, Department of Pediatric Infectious Diseases, B J Wadia Hospital for Children, Mumbai, India. Email:

Keywords: Hereditary spherocytosis, Pregnancy, Spherocytosis, Splenectomy.

Clinical Problem:
A 38 year old female, G3P1L1A1 at 31+4 weeks of gestation with expected date of delivery in February 2024 and a known case of hereditary spherocytosis with splenectomy done 11 years back in 2012 (at 16th weeks of gestation during the second pregnancy) was referred to the infectious diseases department regarding her requirement and safety of immunization against capsulated organisms like Pneumococcal, Meningococcal and Hemophilus Influenza type b (Hib).
Her first pregnancy was in 2011 which ended in a spontaneous abortion at 2 months for which Dilatation and Curettage (D&C) was done. Her second child, an 11 years old female was born at full term via normal vaginal delivery in 2012. During this pregnancy she had undergone splenectomy in view of hereditary spherocytosis and requirement of blood transfusion at 16 weeks of gestation. She received pneumococcal, meningococcal and HiB vaccine at that time (details not available). The current pregnancy was her third gestation. She also had pregestational hypothyroidism which was under maintenance with 100 mcg of thyroid supplement.
On examination, her blood pressure was 110/70 mm of hg. She had no pallor or icterus on examination. Per abdominal examination shows a fundal height of 30 cms with a single fetus in cephalic presentation and regular fetal heart sounds at 148 bpm. Laboratory investigations done two weeks ago showed hemoglobin of 11.7 gm/dL, red blood cell count of 3.84 X 106/cumm, white blood cell count of 10.88 X 103/cumm and platelet count of 402 X 109/L. Her thyroid profile showed serum TSH of 0.622 micro IU/mL, serum free T4 of 1.14 ng/dl and serum free T3 of 3.05 pg/mL. Oral glucose tolerance test (GTT ) with 75 gms of glucose shows fasting blood glucose of 86 mg/dl, 1 hour post prandial glucose of 118 mg/dl and 2 hour post prandial glucose of 97 mg/dl.
Ultrasonography (USG) at 29+6 weeks gestation showed a single intrauterine gestation in breech presentation, head circumference of 26.77 cm, biparietal diameter of 7.03 mm, femur length of 5.51 mm and abdominal circumference of 25.82 cm with no congenital malformation seen and normal amniotic fluid index (AFI). The estimated fetal weight was 1400 ± 204 gm.

Is any vaccination recommended at this stage? If yes, are they safe to be administered?

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