title: Fetal schistocytic hemolytic anemia and umbilical vein varix.
abstract: A rare case of schistocytic hemolytic anemia presenting in a fetus secondary to a varix of the intra-abdominal umbilical vein is reported. A patient was referred to our hospital at 32 weeks of gestation because of an abnormal hypoechoic finding in the fetal liver. Prenatal ultrasound showed turbulent flow through a 12-mm diameter dilatation of the fetal intra-abdominal umbilical vein consistent with a varix. Cardiomegaly also was noted. At birth, the 1098-g, growth-retarded, male neonate was in severe congestive heart failure secondary to anemia as the initial hemoglobin was 5 g/dL. Additional evaluation found the anemia to be secondary to schistocytic hemolysis. After the neonate received a transfusion of packed erythrocytes and supportive care, the anemia quickly resolved, and he was discharged to home doing well after a 6-week stay in the neonatal intensive care unit. Prompt recognition of the varix prenatally and thorough evaluation of the newborn postnatally led to appropriate diagnosis and treatment.
authors.affiliation: Department of Pediatrics and Obstetrics, William Beaumont Hospital, Royal Oak, Michigan, USA.
authors.forename: D G
authors.initials: DG
authors.lastname: Batton
authors.forename: A
authors.initials: A
authors.lastname: Amanullah
authors.forename: C
authors.initials: C
authors.lastname: Comstock
mesh_terms: D000328:Adult; D000745:Anemia, Hemolytic, Congenital / Q000150:complications / Q000196:embryology*; D004913:Erythrocytes, Abnormal / Q000473:pathology*; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D005317:Fetal Growth Retardation; D006333:Heart Failure / Q000151:congenital / Q000209:etiology; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000196:embryology; D008297:Male; D011247:Pregnancy; D016216:Ultrasonography, Prenatal; D014471:Umbilical Veins / Q000473:pathology*; D014648:Varicose Veins / Q000196:embryology*