Differential Diagnosis of Postpartum Hemorrhage in a Patient with Sickle Cell Disease: Case Report and Literature Review

Abstract

Introduction: Sickle cell disease is the most common genetic hemoglobinopathy in Brazil and represents a risk factor for gestational complications, including postpartum hemorrhage (PPH). Accurate diagnosis and appropriate management are essential to reduce maternal morbidity and mortality. Case report: A 37-year-old pregnant woman with sickle cell anemia (SCA), carrying a dichorionic twin pregnancy, developed HELLP syndrome and underwent a cesarean section requiring blood transfusions. On the 13th postoperative day, she presented with severe secondary PPH. Examinations revealed an arteriovenous malformation, for which she underwent arterial embolization. Recurrent bleeding led to a total abdominal hysterectomy. She developed endometritis and received antibiotic therapy. Histopathology confirmed placental accreta. In total, she received 7 units of packed red blood cells and was discharged after stabilization. Discussion: SCA exacerbates the hematological response to hemorrhagic conditions, complicating transfusion management and the diagnosis of underlying causes, such as placental accreta. The overlap of obstetric syndromes, chronic anemia, and infectious complications requires a multidisciplinary approach. Conclusion: Postpartum surveillance of patients with SCA should be intensified, with special attention to unusual causes of PPH. Early detection and targeted management are essential to prevent adverse maternal outcomes.