AbstractsSevere aplastic anemia can be treated successfully with bone marrow transplantation. Cyclophosphamide, commonly used for conditioning of the patient before transplantation, causes reversible sterility. Late teratogenicity for offspring is a potential risk. The present authors report the pregnancy and delivery of a 23-year-old woman who had a successful allograft for severe aplastic anemia.The patient was admitted, 12 months after delivery of a healthy baby, with phlegmonous angina in December 1981. Her blood counts were: hemoglobin, 6.4 gm/dl; leukocytes, 1.24 × 109per liter; and platelets, 17 × 109per liter. The bone marrow was hypocellular. The patient complained of dyspnea and easy bruising. On admission, physical findings were normal except for bleeding manifestations. Liver and spleen were normal. The diagnosis of severe aplastic anemia was established, and the patient was transfused with red blood cells and platelets.Four months after diagnosis, the patient was prepared with 4 × 50 mg/kg body weight cyclophosphamide (days −5 to −2) and received 3.8 × 108nucleated bone marrow cells from her HLA-identical, MLC-nonreactive, ABO major mismatched 24-year-old sister. The red blood cells were removed from the bone marrow graft by centrifugation. Methotrexate was used to prevent graft-versus-host disease (GVH-D), and unirradiated donor buffy coat cells were given on 4 consecutive days postgraft for rejection prophylaxis. The early posttransplantation period was uncomplicated. Granulocytes exceeded 1 × 109per liter on day 46; platelets were administered up to day 18. There was no acute GVH-D, and the patient was discharged on day 39. Normal leukocyte and platelet counts were reached on day 131, but reticulocytosis was delayed until day 330, unless a 2-fold plasmapheresis was performed.A mild graft-host reaction on skin and mucous membranes appeared on day 140 and disappeared without treatment around day 500. After 200 days of cyclophos-phamide-induced secondary amenorrhea, the patient developed regular menses again.About 570 days after bone marrow transplantation, the patient became pregnant and refused an elective abortion. Except for mumps in the 14th week, pregnancy was uneventful. The blood counts remained in the normal range. On day 857 after bone marrow transplantation, the patient was delivered by cesarean section, because of vaginal fibrosis (a residue of chronic graft-host reaction of the mucous membranes), of a normally developed female infant, weighing 3450 gm.Soon after delivery, the newborn developed central cyanosis and tachypnea. Breathing 100 per cent oxygen ameliorated the cyanosis slightly. The condition was diagnosed as persistent fetal circulation syndrome with reactive vasoconstriction of the lung vessels and right-to-left shunting over a patent ductus arteriosus Botalli. After surgical closure of the patent ductus arteriosus Botalli 3 weeks postpartum, the baby recovered quickly. One year after birth, both infant and mother have normal blood counts and Karnovsky scores of 100 per cent.