title: Fetal cerebellar damage in fetuses with severe anemia undergoing intrauterine transfusions.
abstract: OBJECTIVE
  To evaluate radiologic findings and outcomes of cerebellar injuries in fetuses with severe anemia due to RhD alloimmunization undergoing intrauterine transfusions.
  
  
  METHODS
  Imaging of multiplanar neurosonography and magnetic resonance imaging (MRI) were reviewed. Pregnancy outcomes were recorded.
  
  
  RESULTS
  Cerebellar injuries were identified after the first intravascular transfusion in four fetuses. Two of these cases were previously reported. The median hemoglobin concentration was 2.1 g/dL. Prenatal neurosonography identified an echogenic collection involving the cerebellum suggestive for hemorrhage in three cases. A progressive hypoplasia of a hemisphere was demonstrated at follow-up examination in one of these cases. Hypoplasia of a cerebellar hemisphere was seen in the fourth fetus. Ultrasound diagnosis was confirmed by prenatal MRI in two cases. In the third case, the postnatal MRI showed as additional finding vermian involvement. One pregnancy was terminated and autopsy confirmed the presence of infratentorial hemorrhage. The remaining infants were delivered alive. At time of writing, a truncal ataxia was diagnosed in the child with vermian hypoplasia, while the other children have met all age-appropriate milestones.
  
  
  CONCLUSIONS
  A severe anemia seems to put the fetus at risk of cerebellar damage, despite successful intravascular transfusion.
authors.affiliation: a Division of Obstetrics and Prenatal Medicine, Department of Medical Surgical Sciences , St. Orsola Malpighi Hospital, University of Bologna , Bologna , Italy .
authors.forename: Giuliana
authors.initials: G
authors.lastname: Simonazzi
authors.affiliation: a Division of Obstetrics and Prenatal Medicine, Department of Medical Surgical Sciences , St. Orsola Malpighi Hospital, University of Bologna , Bologna , Italy .
authors.forename: Dalila
authors.initials: D
authors.lastname: Bernabini
authors.affiliation: a Division of Obstetrics and Prenatal Medicine, Department of Medical Surgical Sciences , St. Orsola Malpighi Hospital, University of Bologna , Bologna , Italy .
authors.forename: Alessandra
authors.initials: A
authors.lastname: Curti
authors.affiliation: a Division of Obstetrics and Prenatal Medicine, Department of Medical Surgical Sciences , St. Orsola Malpighi Hospital, University of Bologna , Bologna , Italy .
authors.forename: Maria
authors.initials: M
authors.lastname: Bisulli
authors.affiliation: a Division of Obstetrics and Prenatal Medicine, Department of Medical Surgical Sciences , St. Orsola Malpighi Hospital, University of Bologna , Bologna , Italy .
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Pilu
authors.affiliation: b Division of Maternal Fetal medicine, Department of Obstetrics and Gynecology , Jefferson Medical College of Thomas Jefferson university Hospital , Philadelphia , PA , USA , and.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Brill
authors.affiliation: a Division of Obstetrics and Prenatal Medicine, Department of Medical Surgical Sciences , St. Orsola Malpighi Hospital, University of Bologna , Bologna , Italy .
authors.forename: Nicola
authors.initials: N
authors.lastname: Rizzo
authors.affiliation: c Division of Pediatric Neurology, Department of Pediatrics , Nemours/Alfred I. DuPont Hospital for Children , Wilmington , DE , USA.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Berghella
mesh_terms: D000328:Adult; D000740:Anemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D001805:Blood Transfusion, Intrauterine; D002526:Cerebellar Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006801:Humans; D011247:Pregnancy; D012203:Rh Isoimmunization / Q000150:complications*; D014463:Ultrasonography
keywords: Fetal cerebellar damage; intravascular transfusion; magnetic resonance imaging; prenatal ultrasound; severe anemia