Maternal azathioprine therapy and depressed haemopoiesis in the babies of renal allograft patients

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Abstract
Summary. Maternal immunosuppression with azathioprine during pregnancy can depress fetal haemopoiesis resulting in neonatal throm-bocytopenia and leucopenia with the potential for serious sequelae. The effect on the infant of adjusting azathioprine dosage on the basis of maternal total leucocyte count has been studied in 10 pregnancies in eight renal allograft recipients. Throughout the first six pregnancies azathioprine dosage was unchanged and although the characteristic pregnancy leucocytosis was evident it was not maintained in four patients whose leucocyte counts by 32 weeks gestation were significantly less than our norm [10·3 (SD 1·7) ×109/1] and who subsequently had babies with cord leucocyte counts 8·0×109/l, again significantly less than our norm [13·7 (SD 3·9) ×109/1]. A significant correlation existed between maternal leucocyte counts at 32 weeks gestation and at delivery and cord leucocyte count (r=0·847; Pr=0·915; P9/1 but there was no correlation between maternal platelet counts at 32 weeks gestation or at delivery and cord platelet count. For the next four pregnancies policy changed: at 32 weeks gestation azathioprine dosage was halved if maternal leucocyte count was at or below the ISD band (8·6×109/1) for normal pregnancy. All of the infants were haemotologically normal and two patients whose first babies had leucopenia and thrombocytopenia had second babies without problems. Analysis of data from all 10 pregnancies still demonstrated a significant correlation between cord leucocyte count and maternal leucocyte count at delivery but no longer at 32 weeks gestation. It is concluded that in pregnant renal allograft recipients adjustment of azathioprine dosage so as to maintain maternal total leucocyte count within normal physiological limits for pregnancy avoids neonatal leucopenia and thrombocytopcnia.

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